Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures.

SUMMARY: Pediatric pelvic fractures are serious injuries. Anatomical differences exist between pediatric and adult populations, leading to different causes and rates of death, fracture patterns, and associated injuries. This study is the largest consecutive series of pediatric pelvic fractures from one institution emphasizing the unique aspects seen in pediatrics. One hundred sixty-six children were included. Plain radiography and computed tomography scans were used to classify pelvic fractures. Multisystem injuries occurred in 60%, and 50% sustained additional skeletal injuries. The death rate was 3.6%. Head and/or visceral injuries were the causes of all deaths. Life-threatening hemorrhage did not occur. Urethral injury was not seen as often as in adults. Anterior ring fractures were the most common type, dominated by pedestrian versus motor vehicle trauma. Anatomical differences and mechanism of injury may play a role in these contrasting findings.

Role of computed tomography in the classification and management of pediatric pelvic fractures.

In adults, pelvic computed tomography (CT) scanning plays an important role in the treatment of pelvic fractures; however, the role of CT scanning in the management of pediatric pelvic fractures is unclear. The purpose of this study was to investigate the efficacy of CT scanning in the management of pelvic fractures in children. One hundred three consecutive patients were identified. All patients underwent anteroposterior plain radiographic evaluation; CT scans were performed in 62. Three orthopaedic surgeons independently reviewed the plain radiographs and determined fracture classification and management. Subsequently, each observer was shown corresponding CT scans and again determined classification and management. Interobserver agreement was calculated using Kappa statistics. After the addition of CT scans, the mean changes in classification were nine (15%) and in management two (3%). Plain radiographs alone reliably predicted the need and type of operative intervention. Kappa statistics demonstrated "excellent" agreement for classification and management without and with CT scans. We reliably determined fracture classification and management based on plain radiographs alone.

Rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.

BACKGROUND: The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection. METHODS: Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured. RESULTS: The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection. CONCLUSIONS: The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.

Accuracy of patient care staff in estimating and documenting meal intake of nursing home residents.

OBJECTIVES: To determine the accuracy of patient care staff estimates and documentation of food intake of residents in nursing homes. DESIGN: Prospective, observed, unblinded cohort study. SETTING: Three urban nursing home facilities. SUBJECTS: Staff estimation and documentation of 27 nursing home residents' meal intake. MEASUREMENTS: Actual amount consumed by 27 nursing home residents was ascertained by weighing food and caloric fluids on resident trays before and after one lunch time meal. Staff estimates and documentation of percent of meal consumed was compared with actual intake. RESULTS: Patient care staff estimates differed from actual intake by approximately 20%, and in most instances intake was overestimated. Almost one-third of the residents at risk for nutritional problems were not identified correctly by staff. Chart documentation of meal intake frequently did not reflect either actual amount of meal consumed or the staff's estimation of what was eaten. CONCLUSION: Study findings indicate that the present system used to document nursing home residents' intake is inadequate and that a more accurate mechanism or an entirely different process for identifying residents at risk for nutritional problems should be developed and implemented.

Strength training increases regional bone mineral density and bone remodeling in middle-aged and older men.

To determine the effects of strength training (ST) on bone mineral density (BMD) and bone remodeling, 18 previously inactive untrained males [mean age 59 +/- 2 (SE) yr] were studied before and after 16 wk of either ST (n = 11) or no exercise (inactive controls; n = 7). Total, spinal (L2-L4), and femoral neck BMD were measured in nine training and seven control subjects before and after the experimental period. Serum concentrations of osteocalcin, skeletal alkaline phosphatase isoenzyme, and tartrate-resistant acid phosphatase were measured before, during, and after the experimental program in all subjects. Training increased muscular strength by an average of 45 +/- 3% (P < 0.001) on a three-repetition maximum test and by 32 +/- 4% (P < 0.001) on an isokinetic test of the knee extensors performed at 60 degrees/s. BMD increased in the femoral neck by 3.8 +/- 1.0% (0.900 +/- 0.05 vs. 0.933 +/- 0.05 g/cm2, P < 0.05) and in the lumbar spine by 2.0 +/- 0.9% (1.180 +/- 0.06 vs. 1.203 +/- 0.06 g/cm2, P < 0.05). However, changes in lumbar spine BMD were not significantly different from those in the control group. There was no significant change in total body BMD. Osteocalcin increased by 19 +/- 6% after 12 wk of training (P < 0.05) and remained significantly elevated after 16 wk of training (P < 0.05). There was a 26 +/- 11% increase in skeletal alkaline phosphatase isoenzyme levels (P < 0.05) after 16 wk of training.(ABSTRACT TRUNCATED AT 250 WORDS)

Strength training accelerates gastrointestinal transit in middle-aged and older men.

Seven healthy, untrained men (age 60 +/- 2 yr, mean +/- SEM) were studied to determine the effects of a 13-wk total body strength training program on gastrointestinal transit time (GITT). Whole bowel transit time and mouth-to-cecum transit time were assessed before and after the training program. Subjects recorded dietary intake for the 5 d preceding their baseline GITT tests and repeated that diet for 5 d prior to their GITT tests after training. No significant changes in weight or VO2max were observed as a result of the training program. There was a small but significant decrease in body fat assessed by hydrodensitometry (23.4 +/- 2.6% vs 21.8 +/- 2.6%, P less than 0.05). The training program resulted in a 41 +/- 5% increase (P less than 0.001) in upper body strength and a 45 +/- 6% increase (P less than 0.001) in lower body strength. A 38 +/- 6% increase (P less than 0.01) in peak torque of the knee extensors was also observed at 60 degrees.s-1. The training program significantly accelerated whole bowel transit time (41 +/- 11 vs 20 +/- 7 hr; P less than 0.01). There was no significant change in mouth-to-cecum transit time. Thus, a strength training program can accelerate whole bowel transit time in previously sedentary middle-aged and older men. This effect appears to be in the large intestines.