RESUMO
Purpose: Conventional radiography is frequently performed in pediatric patients in whom finger fractures are suspected. However, until now, the rate of positive findings of finger radiographic examinations in pediatric patients is unknown. This study aimed to evaluate the number of positive findings in the standard radiographic examinations of finger injuries in pediatric patients in a Level 1 trauma center systematically. Methods: We conducted a retrospective study on all children 0-16 years old admitted for acute finger injury in the Emergency Department of a University Hospital during the first semester of 2019 and received a radiographic examination. Their demographic characteristics, fracture pattern, and treatment were then analyzed and interpreted. Results: Out of 478 finger injuries reviewed in this cohort, 160 X-rays revealed positive for a fracture giving a fracture rate of 33.5%. More than half of them (51.9%) occurred in the age group of adolescents (11-16 years). Among all finger fractures, only 3.8% of them treated surgically. Conclusion: In this study, a relevant amount of standard finger radiographs revealed a low fracture rate and a rare operative indication of 3.8%. Therefore, indications for X-rays should be reviewed properly and alternative procedures should be discussed. Clinical decision rules should be developed and the necessary pathways must be implemented to minimize radiation exposure, waiting time, and costs.Level of evidence: level IV.
RESUMO
PURPOSE: We aimed to study generational changes in the dimensions of cervical and lumbar bony spinal canals in Western Switzerland. METHODS: A total of 254 patients were retrospectively included, 144 of whom were born during 1940-1949 and 110 during 1970-1979. Cervical spine CTs were performed as part of the spinal clearance procedure following trauma (n = 135) or while investigating neurological symptoms (CT angiography, n = 119). Three independent observers digitally measured the cross-sectional area (CSA) at pedicle levels from C0 to C7 and the anteroposterior diameter (APD) at C3, C5, and C7. In addition, lumbar spine CSAs and APDs were measured on whole body trauma or abdominal CTs, which were also available for 134 patients. RESULTS: Mean CSAs at pedicle levels were numerically smaller in the younger patient group in both cervical and lumbar spine, with the difference reaching statistical significance at all lumbar levels (p ≤ 0.024) except L5. Cervical APDs showed no difference between groups. Subgroup analysis revealed that younger CT angiography patients had a significantly smaller CSA at C1 (p = 0.018) and a similar trend at C4 (p = 0.053). There was moderate positive correlation between cervical and lumbar CSAs, taking C4 and L3 as reference (r = 0.509, p < 0.01). CONCLUSIONS: Younger generation patients have smaller bony spinal canals also in the cervical spine even though this difference is less marked than at the lumbar level. There is, nevertheless, moderate positive correlation between these two anatomical regions. Perinatal factors that adversely influence spinal growth, such as increased maternal age and smoking, could explain these generational changes, given that body height has increased during the same time period. The lesser difference observed in the cervical spine could be due to later closure of the neurocentral synchondrosis at this level.
