Journal of pediatric orthopedics
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Comparative Study
Scoring of pediatric orthopaedic polytrauma: correlations of different injury scoring systems and prognosis for hospital course.
Trauma scoring systems were compared among themselves and to recovery variables in a cohort of 91 pediatric polytrauma patients with orthopaedic injuries. They included the Trauma Score (TS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Modified Abbreviated Injury Severity Scale (MISS), Pediatric Trauma Score (PTS), and TRISS-b survival statistic. Significant correlations between scoring systems and hospital course parameters existed. ⋯ The TS correlated most strongly with ventilatory days and complications of immobilization (r2 = 0.77, 0.58). The TS should be used early in the assessment of the pediatric polytrauma patient, along with the TRISS-b statistic. If they predict prolonged intensive care unit and ventilatory days and hospital complications, operative fracture management should be strongly considered.
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The results of intramedullary rodding of long bones of 16 children with osteogenesis imperfecta, over a 10-year period, were analyzed. Sheffield elongating rods or non-elongating rods were used. ⋯ Migration of the rods, encountered frequently, appears to be related to improper placement of the rods in the bone. It seems likely that if care is taken to ensure precise placement of a rod of appropriate size, several of these complications may be avoided.
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Hereditary multiple exostoses (HME) is traditionally described as a skeletal dysplasia. However, the discovery that the EXT family of tumour suppressor genes are responsible for HME suggests that it is more appropriate to classify HME as a familial neoplastic trait. ⋯ These data suggest that the growth retardation in HME may result from the local effects of enlarging osteochondromas rather than a skeletal dysplasia effect. This study provides the first clinical rationale for ablation of rapidly enlarging exostoses to reduce growth disturbance.