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Medicina
Special Issues
Management of Pediatric Trauma
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Management of Pediatric Trauma

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pediatrics".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 18689

Special Issue Editors

Prof. Dr. Johannes Mayr

E-Mail Website
Guest Editor
Department of Pediatric Surgery, University Children's Hospital Basel (UKBB), 4056 Basel, Switzerland
Interests: pediatric surgery; pediatric trauma; injury prevention in children; ultrasound imaging; damage control; multiple injuries; pediatric fractures; pediatric joint dislocations; implants for children; compartment syndrome; polytrauma
Special Issues, Collections and Topics in MDPI journals
Dr. Benjamin Frei

E-Mail Website
Guest Editor
Department of Pediatric Surgery, Inselspital Bern, University Hospital Bern, Bern, Switzerland
Interests: pediatric trauma; multiple injuries; pediatric fractures; pediatric joint dislocations; implants for children; compartment syndrome

Special Issue Information

Dear Colleagues,

We cordially invite you to contribute to a Special Edition of Medicina dedicated to the management of injuries in children and adolescents.

Management of pediatric trauma has been subjected to several changes recently. Many pediatric hospitals have implemented Accident and Emergency (A&E) units for children and adolescents. In A&E units, injured children and adolescents are seen first by nurses for triage and pain treatment. Pediatric emergency physicians care for the majority of patients, and pediatric surgeons, orthopedic surgeons, pediatric radiologists, and pediatric anesthesiologists are not involved in primary treatment decisions. Therefore, the management of injured children by pediatric surgeons, surgeons, orthopedic surgeons, pediatric radiologists, and pediatric anesthesiologists has shifted from primary care to secondary interventions. Many specialists are involved in the management of injuries in children and adolescents, such as neurosurgeons, plastic surgeons, general surgeons, ORL surgeons, maxillofacial surgeons, radiologists, and pediatric intensive care physicians. Whereas in level III pediatric hospitals, intensive care for children and adolescents is provided by specialized pediatric intensive care nurses and physicians, intensive care for children and adolescents in general hospitals is provided by adult intensive care nurses, anesthesiologists, and intensive care physicians.

The public awareness of battered child issues led to a higher rate of consultations for children with suspected non-accidental trauma at A&E units. In addition, due to the increasing number of children and adolescents in migration, more injured children and adolescents with a migration background are referred to pediatric A&E units. This trend requires integration of migration medical knowledge into pediatric trauma care.

Treatment of long bone fractures in children shows an ongoing trend towards surgical stabilization of fractures, especially in older children and adolescents. However, the majority of fractures in children are treated by conservative methods with good outcomes. Cast materials for children changed from plaster of Paris towards fiberglass and polymer cast materials, causing significant amounts of problematic waste. There is a recent trend towards degradable biologic cast materials for children and adolescents.

Radiologic imaging of injuries in children and adolescents follows the ALARA (as low as reasonably achievable) principles to reduce ionizing radiation to a minimum in children and adolescents. Alternative imaging methods, such as magnetic resonance imaging (MRI) and ultrasound imaging, are increasingly used for diagnostic purposes in injured children.

Prof. Johannes Mayr
Dr. Benjamin Frei
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pediatric trauma
  • Injury prevention in children
  • Ultrasound imaging
  • Damage control
  • Multiple injuries
  • Pediatric fractures
  • Pediatric joint dislocations
  • Implants for children
  • Compartment syndrome
  • Polytrauma

Published Papers (6 papers)

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10 pages, 1156 KiB  
Article
Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management
by Ivona Djordjevic, Dragoljub Zivanovic, Ivana Budic, Ana Kostic and Danijela Djeric
Medicina 2021, 57(8), 734; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080734 - 21 Jul 2021
Cited by 4 | Viewed by 2465
Abstract
Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the [...] Read more.
Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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10 pages, 1318 KiB  
Article
Treatment of Unstable Occipital Condylar Fractures in Children—A STROBE-Compliant Investigation
by Ryszard Tomaszewski, Artur Gap, Magdalena Lucyga, Erich Rutz and Johannes M. Mayr
Medicina 2021, 57(6), 530; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060530 - 25 May 2021
Cited by 1 | Viewed by 2543
Abstract
Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson–Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated [...] Read more.
Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson–Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson–Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson–Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5–14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3–11 points) and SF-36 score (median: 91 points; range: 64–96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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10 pages, 601 KiB  
Article
First-Time Acute Lateral Patellar Dislocation in Children and Adolescents: What about Unaffected Knee Patellofemoral Joint Anatomic Abnormalities?
by Rasa Simonaitytė, Saulius Rutkauskas, Emilis Čekanauskas, Liutauras Labanauskas and Vidmantas Barauskas
Medicina 2021, 57(3), 206; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030206 - 26 Feb 2021
Cited by 3 | Viewed by 3929
Abstract
Background and Objectives: Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this study was to identify key differences and correlations of the patellofemoral joint (PFJ) morphology [...] Read more.
Background and Objectives: Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this study was to identify key differences and correlations of the patellofemoral joint (PFJ) morphology between intact and contralateral injured knees in a first-time traumatic LPD population aged under 18 years. Materials and Methods: The data were gathered prospectively from a cohort of 58 patients (35 girls and 23 boys). The prevalence and combined prevalence of patella alta (PA) and trochlear dysplasia (TD) in both knees of patients were evaluated using X-ray by two radiologists. Results: The PFJ of patients’ intact knees had a lower rate of TD (1.72% vs. 5.2%) and a less common combination of PA with shallow femoral sulcus (SFS) (22.4% vs. 44.8%) but more frequent PA (62.1% vs. 41.4%) compared with their injured knees. We noted statistically significant positive correlations (SSPCs) between the femoral sulcus angle (FSA) and PA in patients with intact (r = 0.37; p < 0.005) and contralateral injured knees (r = 0.33; p < 0.05). Conclusion: There were SSPCs between the FSA and PA in both gender and age groups of patients with intact and contralateral injured knees. The SSPCs between the FSA and PA of intact knees were higher in the patients with a more dysplastic PFJ anatomy (PA and TD) of the injured knees as compared to patients with only PA of the injured knees. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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11 pages, 2699 KiB  
Article
Hand Injuries in the Polish Silesian Paediatric Population—An Exploratory Cross-Sectional Study of Post-Traumatic X-rays
by Maciej Cebula, Sandra Modlińska, Magdalena Machnikowska-Sokołowska, Jacek Komenda, Agnieszka Cebula, Jan Baron and Katarzyna Gruszczyńska
Medicina 2020, 56(10), 550; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56100550 - 20 Oct 2020
Cited by 3 | Viewed by 2025
Abstract
Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. [...] Read more.
Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. Not only are they a significant factor in health care costs, but they may also lead to detrimental and long-term consequences for the patient. The discrepancy observed between the published studies suggests a geographical variation in their epidemiology. The aim of this study is to determine the localisation of injuries and fractures involving the hand in the paediatric population of the Polish Silesia region. This exploratory cross-sectional study involved 1441 post-traumatic hand X-ray examinations performed at the Department of Diagnostic Imaging of the John Paul II Upper Silesian Child Health Centre in Katowice between January and December 2014. Materials and Methods: The study group consisted of 656 girls and 785 boys who were 11.65 ± 3.50 and 11.51 ± 3.98 years old, respectively (range: 1–18 years). All examinations were evaluated for the location of the injury and presence of fracture(s). Results: Finger injuries were dominant (n = 1346), with the fifth finger being the most frequently injured (n = 381). The majority of injuries were observed among children who were 11 years old (n = 176), with a visible peak in the 11- to 13-year-old group. A total of 625 bone fractures were detected. Fractures of the proximal phalanges (n = 213) and middle phalanges (n = 159) were most common, and fifth finger (n = 189) predominance was again observed. A gender-independent positive correlation was found between patients’ age and finger injuries (p < 0.01) as well as metacarpal injuries (p < 0.01). There was no correlation between patients’ age and fractures in these locations (p > 0.05). Metacarpal injuries (p < 0.01), finger injuries (p < 0.01), fractures (p = 0.01), and fractures with displacement (p = 0.03) were more common among males regardless of age. Conclusions: The results indicate that 11-year-old boys are at an increased risk of hand injuries and fractures. The distal and middle phalanges of the right hand, especially of the fifth digit, were the most susceptible to fracture localisation. Thus, injuries in these areas should be perceived as most likely to cause fractures and therefore demand careful examination. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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6 pages, 1042 KiB  
Case Report
The Important Role of the Radiologist in Determining the Indications for the Surgical Treatment of Neuroblastoma with Vascular Image-Defined Risk Factors: A Case Report
by Patrycja Sosnowska-Sienkiewicz, Przemysław Mańkowski, Anna Wojas, Katarzyna Jończyk-Potoczna and Danuta Januszkiewicz-Lewandowska
Medicina 2021, 57(3), 279; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030279 - 17 Mar 2021
Cited by 3 | Viewed by 1876
Abstract
The International Neuroblastoma Risk Group Staging System (INRGSS) is based on the age of patients and preoperative imaging, with attention paid to whether the primary tumor is affected by one or more of specific image-defined risk factors (IDRFs). This publication presents a 2.5-year-old [...] Read more.
The International Neuroblastoma Risk Group Staging System (INRGSS) is based on the age of patients and preoperative imaging, with attention paid to whether the primary tumor is affected by one or more of specific image-defined risk factors (IDRFs). This publication presents a 2.5-year-old boy with neuroblastoma who had an accidental ligation of the celiac trunk during tumor resection. The consequences of this complication were pancreatic and spleen ischemia and necrosis, ischemia, and perforation of the common bile duct, gallbladder, stomach, and duodenum. The aim of this publication was to highlight the great role of the radiologist in determining the indications for neuroblastoma tumor removal, especially with current vascular IDRFs, and to show how the radiologist’s insightful approach can save the patient from irreversible complications. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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7 pages, 1610 KiB  
Case Report
The Rare Case of Perirenal Abscess in a Child—Possible Mechanisms and Methods of Treatment: A Case Report and Literature Review
by Patrycja Sosnowska-Sienkiewicz, Ewa Bućko and Przemysław Mańkowski
Medicina 2021, 57(2), 154; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020154 - 09 Feb 2021
Viewed by 5108
Abstract
Renal and perirenal abscesses are very rare in children. They can be present as an acute emergency condition or insidiously as a chronic disease. The diagnosis is not so obvious, and it is a big challenge, especially when it can simulate a kidney [...] Read more.
Renal and perirenal abscesses are very rare in children. They can be present as an acute emergency condition or insidiously as a chronic disease. The diagnosis is not so obvious, and it is a big challenge, especially when it can simulate a kidney tumor. The treatment can be conservative, preferably with targeted antibiotics, or surgical, consisting primarily of drainage. This publication aims to present a clinical case in which both diagnosis and treatment were a big challenge for the entire treatment team. A 10-year-old male patient was admitted to the hospital because of mild abdominal pain and a temperature of 37.5 °C. The symptoms lasted for a week. In the computed tomography (CT), the lesion’s dimensions were 11.1 × 8.2 × 25 cm, and inflammation, abscess, cyst, and abdominal tumor have been suggested. The decision about surgical treatment was made. An enormous abscess near the right kidney was localized. The patient’s condition stabilized after surgery. Unfortunately, due to persistent purulent reservoirs, a second laparotomy was necessary. During the extensive diagnostic cystourethrography performed, vesicoureteral reflux was visualized. In conclusion, though a perinephric abscess is very rare in children, it should be taken into consideration in patients with non-specific abdominal symptoms. The imaging using ultrasound and CT scan with contrast enhancement is crucial to recognize and properly treat the condition. In terms of a small abscess, the only antimicrobial treatment using antibiotics of a broad spectrum can be considered. However, the drainage of an abscess, either percutaneous or open, should be used. For the large abscess, the open drainage seems to be a primary method of treatment. The importance of cooperation in a multidisciplinary team is crucial, as the diagnosis and treatment of underlying causes are essential. Full article
(This article belongs to the Special Issue Management of Pediatric Trauma)
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