Patterns of injury and management of children with pelvic fractures at a non-trauma center.

BACKGROUND: Pelvic injuries in young children are rare, and it has been difficult to establish clinical guidelines to assist providers in managing blunt pelvic trauma, especially in non-Level 1 trauma centers. OBJECTIVE: Our aim was to describe the relationship among clinical findings, mechanism of injury, and the radiographic resources utilized in children with pelvic fractures presenting to a non-Level 1 trauma center. METHODS: A retrospective review of patients with a pelvic fracture treated in two urban pediatric Level 3 emergency departments was performed. RESULTS: Between 2001 and 2010, a total of 208 patients were identified. Avulsion/iliac wing fractures were the most common fractures (58.7%), and sports-related injuries were the most common mechanism of injury (50.0%). Children with sports-related injuries were more likely to sustain an avulsion fracture (p<0.001), less likely to have a computed tomography scan obtained in the emergency department (p<0.001), and less likely to have an associated injury (p<0.001) than other children. Children struck by a motor vehicle (p<0.001) or involved in a motor vehicle accident (p<0.001) were more likely to receive a computed tomography scan (p<0.001) and have associated head and extremity injuries (p<0.001). Mechanism of injury was associated with abnormal computed tomography scans. Nearly all patients were treated nonoperatively (98.1%) and no deaths were reported in this study. CONCLUSIONS: Patterns of injury, based on mechanism of injury, have been reported to assist the assessment and management of children with minor pelvic injuries.

Does age affect analgesia provision at discharge among children with long bone fractures requiring emergency care?

BACKGROUND: Inadequate treatment of painful conditions in children is a significant and complex problem. The wide range of cognitive abilities associated with a child's age is a particular challenge for providers treating children with painful conditions. STUDY OBJECTIVE: To examine the effect of patient age on the provision of analgesic medicines at discharge in children treated emergently for a long bone fracture. METHODS: A retrospective review was performed of all patients during a 1-year period with a long bone fracture treated in two urban pediatric Emergency Departments (EDs). RESULTS: Eight hundred seventy-eight patients were identified who met our inclusion criteria. Nearly 60% of patients received a prescription for an opioid-containing medicine and 19% received a prescription for an over-the-counter analgesic medicine at ED discharge. Patients younger than 4 years old had lower pain scores, less severe fractures, and overall were significantly less likely to receive an opioid-containing prescription compared to children 4 years old or greater. In children with more severe fractures requiring reduction in the ED, no significant age-related differences were noted in opioid prescription rates. No age-related significant differences were noted for over-the-counter prescription analgesic medicines provided at discharge. CONCLUSION: Young patient age is associated with different analgesic prescription patterns in children treated in the ED for a long bone fracture.

Hip disorders in the adolescent.

This article deals with common hip problems in the adolescent age group. Some of these problems, such as slipped capital femoral epiphysis, require urgent surgical treatment. Early detection is essential. Other problems, such as many of the athletic injuries, are less urgent but important to patients who desire rapid return to full athletic capacity. The emphasis here is on understanding the conditions and diagnosis. Surgical options are mentioned but not detailed. Office management, where appropriate, is discussed against the background of the natural history of the conditions. The intended audience is primary care physicians and orthopedic surgeons who may have limited exposure to some of these conditions.