与孤立性股骨骺骨折儿童非意外创伤相关的研究结果。

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2024-09-01 Epub Date: 2024-05-30 DOI:10.1097/BPO.0000000000002740
Jason Ina, Anne M Dumaine, Christopher Flanagan, Lucas Haase, Rebecca Moore, Clare Rimnac, Allison Gilmore
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引用次数: 0

摘要

背景:患有孤立性股骨骺骨折的小儿患者很难被评估为非意外创伤(NAT)。本研究旨在确定:(1)与疑似 NAT 相关的孤立性股骨骺骨折是否存在人口统计学特征;(2)与疑似 NAT 相关的孤立性股骨骺骨折是否存在相关临床症状:回顾性分析2010年1月至2018年6月期间所有股骨骺骨折患者。我们纳入了年龄小于 4 岁的孤立性股骨骺骨折患者。我们排除了 4 岁及以上的患者、多发性创伤、机动车碰撞以及骨生物学改变的患者。疑似 NAT 的诊断是通过审查有据可查的社会工作评估来确定的。我们记录了骨折特征,包括沿股骨的位置、骨折形态和 NAT 检查的相关结果,包括视网膜出血、硬膜下血肿、先前骨折的证据或皮肤损伤。计算了这些相关结果的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV):共有 144 名患者符合纳入标准。有 50 名患者(35%)接受了社会工作咨询。有 27 名患者(19%)被诊断为疑似 NAT。疑似 NAT 患者的平均年龄为 0.82 岁,无 NAT 患者的平均年龄为 2.25 岁:在目前的研究中,NAT的迹象,如皮肤病变、视网膜出血、硬膜下血肿以及骨骼调查中的既往骨折证据,可能无助于诊断孤立性股骨干骺端骨折患者的疑似NAT:三级诊断研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Findings Associated With Nonaccidental Trauma in Children With Isolated Femoral Diaphyseal Fractures.

Background: Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT.

Methods: All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed. We included patients younger than 4 years old with isolated femoral diaphyseal fractures. We excluded patients 4 years old and older, polytraumas, motor vehicle collisions, and patients with altered bone biology. Diagnosis of suspected NAT was determined by review of a documented social work assessment. We recorded fracture characteristics including location along femur as well as fracture pattern and presence of associated findings on NAT workup including the presence of retinal hemorrhage, subdural hematoma, evidence of prior fracture, or cutaneous lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these associated findings were calculated.

Results: Totally, 144 patients met the inclusion criteria. Social work was consulted on 50 patients (35%). Suspected NAT was diagnosed in 27 patients (19%). The average age of patients with suspected NAT was 0.82 and 2.25 years in patients without NAT ( P <0.01). The rate and type of skin lesions present on exam were not different between the 2 groups. Patients with suspected NAT had no findings of retinal hemorrhage or subdural hematoma, but 5 of 27 patients (19%) had evidence of prior fracture on skeletal survey. The sensitivities of retinal hemorrhage, subdural, and skeletal survey were 0%, 0%, and 19% and the specificities of all were 100%. The NPVs were 39%, 27%, and 63%, respectively. The PPV of skeletal survey was 100%. Since there were no patients in this study with positive findings of retinal hemorrhage or subdural hematoma, the PPV for these could not be assessed.

Conclusions: In the current study, signs of NAT such as skin lesions, retinal hemorrhage, subdural hematoma, and evidence of prior fracture on skeletal survey may not be helpful to diagnosis suspected NAT in patients with an isolated femoral diaphyseal fracture.

Level of evidence: Level III-diagnostic study.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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