• Journal of Trauma and Injury
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• 제34권4호
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• pp.257-262
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• 2021

Purpose: Pediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period. Methods: We conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries. Results: Among the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups. Conclusions: Hand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권3호
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• pp.123-133
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• 2024

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

• 대한두개안면성형외과학회지
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• 제24권3호
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• pp.133-138
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• 2023

White-eyed blowout fractures with extraocular muscle (EOM) entrapment necessitate emergency surgical intervention. However, even after surgery, diplopia or EOM motion limitations may persist due to the incomplete reduction of soft tissue herniation caused by inadequate dissection or unresolved muscle strangulation. In this report, we present a case of postoperative EOM movement limitation in a 5-year-old girl who experienced recurrent restriction in the upward gaze of her right eye 14 days after surgery. Instead of revision surgery, the patient was treated with targeted EOM exercises focusing on the inferior rectus muscle and inferior oblique muscle. The patient was instructed to slowly move her pupils from the central point to the upper and outer sides, then in a straight line from the central point to the lower and inner sides before returning to the center point. On the 28th postoperative day, 2 weeks after initiating the exercises, the patient's EOM motion fully recovered. This case highlights the effectiveness of EOM exercises as a non-surgical treatment approach for improving recurrent EOM movement limitations in the absence of soft tissue herniation following surgical management of blowout fractures in children.

• Advances in biomechanics and applications
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• 제1권3호
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• pp.143-158
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• 2014

Forearm fractures in children are very common among all pediatric fractures. However, biomechanical investigations on the pediatric forearm are rather scarce, partially due to the complex anatomy, closely situated, interrelated structures, highly dynamic movement patterns, and lack of appropriate tools. The purpose of this study is to develop a computational tool for child forearm investigation and characterize the mechanical responses of a backward fall using the computational model. A three-dimensional 10-year-old child forearm finite element (FE) model, which includes the ulna, radius, carpal bones, metacarpals, phalanges, cartilages and ligaments, was developed. The high-quality hexahedral FE meshes were created using a multi-block approach to ensure computational accuracy. The material properties of the FE model were obtained by scaling reported adult experimental data. The design of computational experiments was performed to investigate material sensitivity and the effects of relevant parameters in backward fall. Numerical results provided a spectrum of child forearm responses with various effective masses and forearm angles. In addition, a conceptual L-shape wrist guard design was simulated and found to be able to reduce child distal radius fracture.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.473-480
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• 2022

Purpose: Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use. Methods: Children aged 5-18 years with IBD diagnosed between 2013 to 2017 at the Royal Children's Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected. Results: Over a median follow up of 5.1 (4-6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score -0.80 (-1.65-0.075). Children with LS z-score≤-2.0 (n=14) had lower weight (6.57 [1.78-23.7] vs. 51.1 [26.5-68.7], p=0.0002) and height centiles (3.62 [1.17-17.1] vs. 42 [16.9-67.1], p=0.0001), and higher faecal calprotectin (FCP) (3041 [1182-4192] vs. 585 [139-2419], p=0.009) compared to children with LS z-score>-2.0. No fractures were reported. Of 28 children who underwent a second DXA 1.6 (1.1-2.2) years following initial DXA, no significant change in z-scores occurred. Conclusion: Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.

• Clinical and Experimental Pediatrics
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• 제53권3호
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• pp.286-293
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• 2010

Peak bone mass is established predominately during childhood and adolescence. It is an important determinant of future resistance to osteoporosis and fractures to gain bone mass during growth. The issue of low bone density in children and adolescents has recently attracted much attention and the use of pediatric dual-energy X-ray absorptiometry (DXA) is increasing. The process of interpretation of pediatric DXA results is different from that of adults because normal bone mineral density (BMD) of children varies by age, body size, pubertal stage, skeletal maturation, sex, and ethnicity. Thus, an appropriate normal BMD Z-score reference value with Z-score should be used to detect and manage low BMD. Z-scores below -2.0 are generally considered a low BMD to pediatrician even though diagnoses of osteoporosis in children and adolescents are usually only made in the presence of at least one fragility fracture. This article will review the basic knowledge and practical guidelines on pediatric DXA based on the International Society for Clinical Densitometry (ISCD) Pediatric Official Positions. Also discussed are the characteristics of normal Korean children and adolescents with respect to BMD development. The objective of this review is to help pediatricians to understand when DXA will be useful and how to interpret pediatric DXA reports in the clinical practice for management of children with the potential to develop osteoporosis in adulthood.

• Korean Journal of Radiology
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• 제23권3호
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• pp.343-354
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• 2022

Objective: To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children. Materials and Methods: This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs). Results: The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; p = 0.012) and 0.069 (95% CI, 0.002-0.136; p = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; p = 0.850). Conclusion: A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.

• 대한정형외과스포츠의학회지
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• 제3권1호
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• pp.87-91
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• 2004

목적: 인라인 스케이트를 타던 중 발생한 골절상을 분석하여 골절의 분포 및 경향을 파악 하고자 한다. 대상 및 방법: 2002년 9월부터 2003년 8월까지 1년간 인라인 스케이트를 타다가 골절이 발생하여 입원 가료 하였던 35명의 환자 중 최소 1년 이상 추시가 가능하였던 20명, 20례를 대상으로 환자의 성별, 연령분포, 부위별 빈도, 동반손상, 숙련도별 손상, 손상 유형 등을 후향적으로 분석하였다. 남자가 18명(90$\%$), 여자가 2명(10$\%$)이었고, 연령대별로는 활동성이 강한 연령층인 21$\~$30세 (6명 30$\%$), 31$\~$40세 (6명 30$\%$)의 순이었다. 결과: 상지골절이 12명(60$\%$)로 하지골절 8명(40$\%$)보다 많았다. 손상 부위별 빈도는 족관절부가 7례(35$\%$)로 가장 많았고, 전완부 4례(20$\%$), 수근부 4례(20$\%$), 주관절 3례(15$\%$), 대퇴부 1례(5%$\%$)의 순이었다. 족관절 골절 손상은 Lauge-Hansen 분류 상, 회외 -외회전 형이 4례로 가장 많았으며, 회외-외전 형이 2례, 회내-외회전 형이 1례였고, 전완부 골절손상과 수근부 골절 손상의 경우에는 요골 원위부 골절 3례, 요골-척골 골절 1례, 주상골 골절 2례, 중수골 골절 2례로 넘어질 때 손으로 짚으면서 발생한 골절의 양상이 많았다. 주관절 골절은 2례에서 과상부 골절이었고 1례에서는 외과 골절 이었다. 성장판 손상이 동반된 소아 골절 3례는 모두 Salt-Harris type II 였으며, 보존적 치료를 시행 하였다. 전체 골절 중 6례는 관절 내 골절 이었다. 동반 손상으로는 타박상이 8명 (42.11$\%$)으로 가장 많았고, 숙련도 별로는 인라인 스케이트를 시작한지 3개월 이내의 초보자들이 8명(40$\%$)으로 가장 많았고, 수상 형태로는 넘어짐과 같은 비접촉성 수상이 14명(70$\%$)으로 접촉성 수상(6명 30$\%$)보다 많았다. 11례 (55$\%$)가 수술적 치료를 받았으며, 9례(45$\%$)는 보존적 치료를 받았고, 추시 중에 특별한 합병증은 발생되지 않았다. 결론: 20$\~$30대의 젊은층의 초보자들에서 족관절부의 골절 손상이 가장 많았으므로, 이에 대한 주의가 필요할 것으로 사료된다

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권3호
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• pp.211-216
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• 1993

This is to report functional treatment, as mechano-therapy, of condylar fracture in cases of growing patients. Benoist's appliance was used in 3 cases condylar fractures, provides extraoral elastic forces to external pterygoid muscle. The appliance providing guided exercise of masticatory muscles induces transformative growth of trauma-tic condyles. The results were as follow; 1. Early exercise preventes ankylosis of fractured condyle. 2. Optimal physical exercise therapy induces the normal growth pattern by muscular training and bony remodeling of fractured condyle in children.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2004년도 춘계 학술대회 (제121회) 초록집
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• pp.304-308
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• 2004

Maxillary anterior crown fractures are a common form of injury that mainly affects children and adolescents. The position of maxillary incisors and their eruptive pattern carries a significant risk for trauma. In the pre-adhesive era, fractured teeth needed to be restored either with pin-retained inlays or cast restorations that sacrificed healthy tooth structure and were a challenge for dentists to match with adjacent teeth. But. recently the development of adhesive dentistry has allowed dentists to use the patient's own fragment to restore the fractured tooth. The purpose of this paper is to present 2 cases of reattachment of fractured teeth which had different fracture mode, and to evaluate prognosis of cases.