Journal of pediatric orthopedics
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Physeal fractures of the distal tibia and fibula are common and can be seen at any age, although most are seen in the adolescent. An understanding of the unique anatomy of the skeletally immature ankle in relation to the mechanism of injury will help one understand the injury patterns seen in this population. A thorough clinical exam is critical to the diagnosis and treatment of these injuries and the avoidance of potentially catastrophic complications. ⋯ Displaced fractures should undergo a gentle reduction with appropriate anesthesia while multiple reduction attempts should be avoided. Gapping of the physis >3 mm after reduction should raise the suspicion of entrapped periosteum that will increase the risk of premature physeal closure. Open reduction of displaced Salter-Harris type III and IV fractures is critical to maintain joint congruity and minimize the risk of physeal arrest.
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In adults, pelvic and femoral fractures have a known association with venous thromboembolic disease and, thus, thromboprophylaxis is the standard of care. However, similar data for children are scarce, and recommendations for pediatric prophylaxis are less clear. Our goals were to: (1) analyze the predisposing risk factors, prevalence, and outcome (including mortality) of clinically significant venous thromboembolism; (2) investigate the use of thromboprophylaxis in pediatric trauma patients and ages at which it was given; and (3) determine the impact that central venous catheters had on the occurrence of venous thromboembolism. ⋯ Level II, retrospective study.