- Trauma is the leading cause of death in the United States for children between the ages of 1 and 14.
- Critical differences in the physiologic effects of multi-system injury exist between children and adults.
- The orthopedist’s role in managing hemodynamic instability, vascular insult, and neurologic damage is essential.
- Unlike patients who present with isolated injuries, operative indications and postoperative immobilization differ in the multiply injured pediatric patient.
- Early fracture stabilization is important in managing children with polytrauma and open fractures to protect soft tissues, reduce pain and facilitate rehabilitation.
Description:Trauma is the leading cause of death in the United States for children between the ages of 1 and 14 and costs our society more than 81 billion dollars per year. (Danseco, 2000) With nearly 63% of pediatric polytrauma patients presenting with extremity fractures, the role of the orthopaedic surgeon in managing these patients is critical. (Loder, 1987) Although rarely a cause of mortality, orthopaedic injuries in these patients can cause long-term morbidity. (Demetrediase, 2003)
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- Bae DS, Kadiyala RK, Waters PM: Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop 2001;21:680-8.
- Bliss D, Silen M: Pediatric thoracic trauma. Crit Care Med 2002;30:S409-15.
- Buckley, S.L., Gotschall C, Robertson W Jr, Sturm P, Tosi L, Thomas M, Eichelberger M: The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop 1994;14:449-53.
- Calkins CM, Bensard DD, Moore EE, McIntyre RC, Silliman CC, Biffl W, Harken AH, Partrick DA, Offner PJ: The injured child is resistant to multiple organ failure: a different inflammatory response? J Trauma 2002;53:1058–1063.
- Courville XF, Koval KJ, Carney BT, Spratt KF: Early prediction of posttraumatic in-hospital mortality in pediatric patients. J Pediatri Orthop 2009;29:439-44.
- Danseco ER, Miller TR, Spicer RS: Incidence and costs of 1987–1994 childhood injuries: demographic breakdown. Pediatrics 2000;105:E27.
- Demetriades D, Karaiskakis M, Velmahos GC, Alo K, Murray J, Chan L: Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma 2003;54:1146-51.
- Doak J, Ferrick M: Nonoperative management of pediatric grade 1 open fractures with less than a 24-hour admission. J Pediatr Orthop 2009;29:49-51.
- Flynn JM, Bashyal RK, Yeger-McKeever M, Garner MR, Launay F, Sponseller PD. Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome. J Bone Joint Surg Am 2011;93:937-41.
- Greenbaum B, Zionts LE, Ebramzadeh E: Open fractures of the forearm in children. J Orthop Trauma 2001;15:111-8.
- Gustilo RB, Mendoza RM, William DN: Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24:742-6.
- Guy J, Haley K, Zuspan SJ: Use of intraosseous infusion in the pediatric trauma patient. J Pediatr Surg 1993;28:158-161.
- Hauschild O, Strohm PC, Culemann U, Pohlemann T, Suedkamp NP, Koestler W, Schmal H: Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma 2008;64:449-55.
- Hedequist D, Starr AJ, Wilson P, Walker J: Early versus delayed stabilization of pediatric femur fractures: analysis of 387 patients. J Orthop Trauma 1999;13:490-3.
- Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA: Emergency transport and positioning of young children who have an injury of the cervical spine: The standard backboard may be hazardous. J Bone Joint Surg Am 1989;71:15-22.
- Iobst CA, Tidwell MA, King WF: Nonoperative management of pediatric type I open fractures. J Pediatr Orthop 2005;25:513-7.
- Lim YJ, Lam KS, Lee EH: Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement? J Pediatr Orthop 2007;27:540-6.
- Loder RT: Pediatric polytrauma: orthopaedic care and hospital course. J Orthop Trauma 1987;1:48-54.
- Mayer T, Walker ML, Clark P: Further experience with the modified abbreviated injury severity scale. J Trauma 1984;24:31-4.
- Mendelson SA, Dominick TS, Tyler-Kabara E, Moreland MS, Adelson PD: Early versus late femoral fracture stabilization in multiply injured pediatric patients with closed head injury. J Pediatr Orthop 2001; 21:594-9.
- Oyetunji TA, Haider AH, Downing SR, Bolorunduro OB, Efron DT, Haut ER, Chang DC, Cornwell EE 3rd, Abdullah F, Siram SM: Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care? Am J Surg 2011;201:445-9.
- Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed RL 2nd: Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma 2002; 53(3):452-61
- Patzakis MJ, Wilkins J: Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 1989;(243):36-40.
- Puapong D, Brown CV, Katz M, Kasotakis G, Applebaum H, Salim A, Rhee P, Demetriades D: Angiography and the pediatric trauma patient: a 10-year review. J Pediatr Surg 2006;41:1859-63.
- Rankin JA: Biologicial mediators of acute inflammation. AACN Clin Issue 2004;15:3-17.
- Sauaia A, Moore FA, Moore EE, Norris JM, Lezotte DC, Hamman RF: Multiple organ failure can be predicted as early as 12 hours after injury. J Trauma 1998; 45:291–301.
- Schalamon J, v Bismarck S, Schober PH, Höllwarth ME: Multiple trauma in pediatric patients. Pediatr Surg Int 2003;19:417-23.
- Silber JS, Flynn JM, Koffler KM, Dormans JP, Drummond DS: Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop 2001; 21:446-50.
- Skaggs DL, Friend L, Alman B, Chambers HG, Schmitz M, Leake B, Kay RM, Flynn JM: The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am 2005;87:8-12. Level 4.
- Smith W, Shurnas P, Morgan S, Agudelo J, Luszko G, Knox EC, Georgopoulos G: Clinical outcomes of unstable pelvic fractures in skeletally immature patients. J Bone Joint Surg Am 2005;87:2423-31.
- Wilkinson JD, Pollack MM, Ruttimann UE, Glass NL, Yeh TS: Outcome of pediatric patients with multiple organ failure. Crit Care Med 1986; 14:271–274.
- Yang EC, Eisler J: Treatment of isolated type I open fractures: is emergent operative debridement necessary? Clin Orthop Relat Res 2003;(410):289-94.