[Thermal injuries : Clinical and acute management in pediatric practice]. / Thermische Verletzungen : Klinik und Akutmanagement in der pädiatrischen Praxis.

BACKGROUND: Each year 30,000 children suffer from burn injuries in Germany and 2000 of these children must be treated in special pediatric burn centers. Approximately two thirds of these children are less than 4 years old, 70% of thermal injuries are due to scalding with hot liquids. OBJECTIVES: The aim of this article is to give an overview of the characteristics of pediatric burn trauma with recommendations for initial treatment, surgical therapy as well as follow-up treatment. CONCLUSION: Physicians are especially challenged by pediatric burn injuries which can cause lifelong stigma by scarring and other physical defects. The treatment of pediatric thermal injuries should be performed in clinics with expertise in treating pediatric burns to achieve optimal results.

[Predicting growth patterns after supracondylar fracture of the humerus in childhood]. / Wie lässt sich die Wachstumsprognose nach kindlicher suprakondylärer Humerusfraktur erfassen?

Supracondylar fracture of the humerus is the most frequently investigated fracture in children. However, systematic studies about postoperative growth patterns cannot be found in the literature. In this retrospective study, the authors attempt to delineate the configuration of supracondylar fractures which allow spontaneous correction of a malalignment or cause post-traumatic growth disturbances. The study included 256 children with supracondylar fracture of the humerus: 184 of them (71.9%) were available for longterm follow-up. The plain films of these children were reviewed and the Baumann and shaft-capitulum angles recorded. Spontaneous correction of a primarily displaced fracture was found in 13.0% ( n=21) of all fractures in the sagittal plane. Spontaneous correction in the frontal plane could not be shown. Growth disturbance was discovered in 10.5% ( n=16) in the frontal plane. No growth disturbance was demonstrated in the sagittal plane. The relatively small number of growth disturbances can be attributed to the low growth potential of the distal physeal plate of the humerus. Growth disturbances with secondary rotational errors were not observed in this study. Spontaneous corrections of alignment in the sagittal plane are only possible under a certain age. Spontaneous correction in the frontal plane, however, is inadequately assessed with this study. The design of a prospective study was formulated to assess how to improve the therapeutic management of supracondylar fractures and to answer additional open questions. Follow-up radiographs and standardized clinical evaluations have to be performed at the time of first free range of movement and 2 years after the trauma. This study will investigate whether therapeutic progress at follow-up is better evaluated with radiological or clinical means.

[Incidence of pseudarthroses in open fractures: analysis of 948 open fractures]. / Inzidenz von Pseudarthrosen bei offenen Frakturen: Analyse von 948 offenen Frakturen.

In a retrospective and prospective analysis of 948 open fractures, treated at the institution of the authors in the years from 1981 to 1989, approximately 155 variables were used to deduce factors influencing the development of posttraumatic non-unions. This analysis reveals that only variables describing the bone injury show a statistical significant influence on posttraumatic non-union. Consideration of the results of the retrospective analysis in the management protocol of open fractures led to a significant decrease of non-union rates in the prospective series of 651 open fractures. An unchanged statistical influence in the development of non-unions could be found for factors representing the bone damage of the underlying injury. Variables describing the soft-tissue injury show a linear regression with the duration of bone healing time. Using the Hannover Fracture Scale is an appropriate tool for treatment control and risk prediction concerning post-traumatic non-unions.