DISTAL RADIUS FRACTURES IN CHILDREN – CAUSES AND PLACES OF OCCURRENCE

Prijelomi distalnog dijela radijusa najčešći su prijelomi u djece i čine oko 25% svih prijeloma. Glavni mehanizam nastanka je pad na ispruženu ruku. Ovi prijelomi najčešće nastaju kao posljedica nesretnih slučajeva, a rjeđe zbog ozljeda i patoloških stanja. U ovom retrospektivnom istraživanju analizirali smo 182 bolnički liječena prijeloma distalnog radijusa, od čega 61 (29,8%) otpada na epifizeolize. Uzroci su podijeljeni u tri skupine: pad 124 (68,1%), ozljeda u prometu 50 (27,5%) i udarac 8 (4,4%). Padovi najčešće nastaju tijekom igre ili sporta – 72 (39,6%), a prometne ozljede tijekom vožnje bicikla – 30 (52%) i koturaljki – 25 (43%). Djeca su se najčešće ozljeđivala na mjestima sportske i rekreacijske aktivnosti – 115 (63%), na ulici 38 (21%) te u školi 16 (9%). U naše djece najveća je pojavnost prijeloma distalnog radijusa tijekom sportskih i rekreacijskih aktivnosti, a najmanja u školi i kod kuće.Distal radius fractures are the most common fractures in children and account for about 25% of all fractures. The main mechanism of occurrence is a fall on the outstretched hand. These fractures usually occur as a result of accidents, and rarely because of injuries and pathological conditions. In this retrospective study, we analyzed 182 hospital-treated distal radius fractures, of which 61 fractures (29.8%) represent epiphysiolysis. The causes are divided into three groups: fall 124 (68.1%), injuries in traffic 50 (27.5%), and strikes 8 (4.4%). Falls usually occur during sport or game playing 72 (39.6%), and traffic injuries occur during cycling 30 (52%) and roller skating 25 (43%). Children were most often injured in the areas of sports and recreational activities 115 (63%), on the street 38 (21%), and at the school 16 (9%). In our children the highest incidence of distal radius fractures was during sports and recreational activities, and the lowest in school and at home

Fizikalna svojstva sadrenih zavoja [Physical properties of plaster bandages]

The physical properties of plaster bandages are a very important factor in achieving the basic functions of immobilization (maintaining bone fragments in the best possible position), which directly affects the speed and quality of fracture healing. This paper compares the differences between the physical properties of plaster bandages (mass, specific weight, drying rate, elasticity and strength) and records the differences in plaster modeling of fast bonding 10 cm wide plaster bandages, from three different manufacturers: Safix plus (Hartmann, Germany), Cellona (Lohman Rauscher, Austria) and Gipsan (Ivo Lola Ribar ltd., Croatia). Plaster tiles from ten layers of plaster, dimension 10 x 10 cm were made. The total number of tiles from each manufacturer was 48. The water temperature of 22 °C was used for the first 24 tiles and 34 'C was used for the remainder. The average specific weight of the original packaging was: Cellona (0.52 g/cm3), Gipsan (0.50 g/cm3), Safix plus (0.38 g/cm3). Three days after plaster tile modeling an average specific weight of the tiles was: Gipsan (1.15 g/cm3), Safix plus (1.00 g/cm3), Cellona (1.10 g/cm3). The average humidity of 50% for Safix plus and Cellona plaster tiles was recorded 18 hours after modeling, while for the Gipsan plaster tiles, this humidity value was seen after 48 hours. On the third day after plaster modeling the average humidity of the plaster tiles was 30% for Gipsan, 24% for Safix and 16% for Cellona. Cellona plaster tiles made with 34 °C water achieved the highest elasticity (11.75±3.18 MPa), and Gipsan plaster tiles made with 22 °C had the lowest (7.21±0.9 MPa). Cellona plaster tiles made with 34 °C water showed maximum material strength (4390±838 MPa), and Gipsan plaster tiles made with 22 °C water showed the lowest material strength (771±367 MPa). The rigidity and strength of Cellona and Gipsan plaster are higher in tiles made in warmer water, and for Safix plus are higher in tiles made in cooler water. All three types of plaster differentiate in physical properties. The differences in mass and specific weight before and after plaster modeling are minimal. There are greater differences in drying rate, elasticity and strength between the three different plaster materials

EXOTHERMIC REACTIONS OF PLASTER IMMOBILIZATION – ANALYSIS OF THREE KINDS OF PLASTER BANDAGES

Egzotermna reakcija sadre iznimno je važno svojstvo koje treba poznavati s obzirom na komplikacije što mogu nastati zbog povišenja temperature u tijeku sadrenja. Razvoj komplikacija izravno utječe na tijek, duljinu i kvalitetu liječenja. U ovom radu bilježe se temperature površine sadrenih pripravaka veličine 10 × 10 cm, brzovežućim sadrenim zavojem širine 10 cm, triju različitih proizvođača: Safix plus (Hartmann, Njemačka), Cellona (Lohmann & Rauscher, Austrija) i Gipsan (Ivo Lola Ribar d. o. o., Hrvatska). Priređene su tri debljine sadrenih pločica (10, 15 i 30 slojeva). Sadrenje je načinjeno u vodi temperature 22 i 34 °C. Unatoč sličnom obrascu ponašanja svih triju sadrenih zavoja izmjerene su razlike. Sve tri vrste sadrenih zavoja koji se rabe u Hrvatskoj u standardnim uvjetima sadrenja imaju nisku razinu egzotermne reakcije, a prosječne su površne temperature niske te nema potencijalne opasnosti od opeklinskih ozljeda. Ako se sadrenje obavljalo u vodi temperature 34 °C, najviše srednje temperature zabilježene su na pločicama (u 15 slojeva) sadrenog zavoja Gipsan (46,2 °C), zatim Cellone (41,3 °C) i Safixa plus (38,9 °C). Pri istoj temperaturi vode sadrenja najviša srednja temperatura izmjerena je na površini pločice (30 slojeva) sadrenog zavoja Gipsan (48,4 °C), zatim Cellone (45,4 °C), a najniža kod pločica sadrenog zavoja Safix plus (41,7 °C). Kada se rabe u debljini od 15 do 30 slojeva, a sadre se vodom temperature 34 °C, sadrene pločice svih proizvođača razvijaju srednje temperature više od 40 °C, u trajanju od 8 do 12 minuta. Od ispitivanih sadrenih zavoja Gipsan (Ivo Lola Ribar d. o. o., Hrvatska) razvijao je najviše temperature, a neke pločice bile su ugrijane na 50 °C. Razine egzotermnih reakcija ispitivanih sadrenih zavoja međusobno se razlikuju prema svim ispitivanim uvjetima, posebice pri sadrenju vodom temperature 34 °C.Exothermic reaction of plaster is a very important characteristic to understand, especially when it comes to complications which can occur during local temperature change during molding plaster of Paris. And these complications directly influence the speed and quality of treatment. In this paper we measured temperatures of plaster bandage tiles 10×10 cm, from three different manufacturers in Croatian hospitals: Safix plus (Hartmann, Germany), Cellona (Lohmann &Rauscher, Austria) and Gipsan ( Ivo Lola Ribar, Croatia). We made three different plaster tiles 10×10 cm, from 10, 15 and 30 layers of plaster bandages. We immersed plaster tiles in two different water temperatures, one group in water 22 °C, and another in 34 °C. Although all plaster bandages have similar chemical characteristics, we have measured some differences. All three kinds of plaster bandages used in Croatia have low exothermic reaction when plaster molding is done in standard conditions, average local temperature is low and there is no danger of local burns. We immersed a plaster tile with 15 layers in water on 34° C, and highest average temperature was measured at Gipsan (46.2 °C), then Cellona (41.3 °C) and Safix plus (38.9 °C). On the same water immersion temperature, on plaster tile with 30 layers average temperatures were Gipsan (48.4°C), Cellona (45.4 °C), and lowest in Safix plus (41.3 °C). Plaster tiles form all manufacturers, when used 15-30 layers thick, and water immersion temperature is 34°C, develop average temperature over 40°C, in duration from 8-12 minutes. Between three different plaster bandages analyzed, Gipsan (Ivo Lola Ribar, Croatia) developed highest temperature, and some plaster tiles were measured over 50 °C

PHYSICAL PROPERTIES OF PLASTER BANDAGES

Fizikalna svojstva sadrenih zavoja bitan su čimbenik u ostvarenju osnovne funkcije sadrenih imobilizacija (zadržavanje ulomaka kosti u dobrom položaju), a time izravno utječu na brzinu i kvalitetu cijeljenja prijeloma. U ovom radu mjere se fizikalna svojstva (masa, specifična težina, brzina sušenja, krutost i čvrstoća) i bilježe razlike sadrenog ­postupka, brzovežućih sadrenih zavoja širine 10 cm triju različitih proizvođača: Safix plus (Hartmann, Njemačka), Cellona (Lohman Rauscher, Austrija) i Gipsan (Ivo Lola Ribar d. o. o., Hrvatska). Sadreno je deset slojeva zavoja u pločice dimenzija 10 × 10 cm. Od svakog proizvoda načinjene su 24 pločice sadrene u vodi temperature 22 °C i isto toliko u vodi temperature 34 °C. Prosječna specifična težina originalnog pakiranja zavoja bila je: Cellona 0,52 g/cm3, Gipsan 0,50 g/cm3, Safix plus 0,38 g/cm3. Tri dana nakon sadrenja prosječna specifična težina pločica bila je: Gipsan 1,15 g/cm3, Safix plus 1,00 g/cm3, Cellona 1,10 g/cm3. Prosječna vlažnost od 50% pločicâ Safix i Cellona trajala je 18 sati, a pločicâ Gipsan 48 sati nakon sadrenja. Treći dan nakon sadrenja prosječna vlažnost pločica Gipsan bila je 30%, Safixa 24%, a Cellone 16%. Najveću krutost imale su pločice sadrenog zavoja Cellona sadrene vodom temperature 34 °C (11,75 ± 3,18 MPa), a najma­nju (7,21 ± 0,9 MPa) pločice sadrenog zavoja Gipsan sadrene vodom temperature 22 °C. Sadreni zavoj Cellona, sadren vodom temperature 34 °C, pokazuje najveću čvrstoću materijala (4390 ± 838 MPa), a najmanju (771 ± 367 MPa) pločice sadrenog zavoja Gipsan sadrene vodom temperature 22 °C. Sadrenjem zavoja Cellona i Gipsan u toplijoj vodi (34 °C) pločice su bile veće krutosti i čvrstoće. Pločice Safix plus nemaju ovo svojstvo. Sve tri vrste sadrenih zavoja razlikuju se prema fizikalnim svojstvima. S obzirom na masu i specifičnu težinu prije i nakon sadrenja razlike su minimalne. Prema brzini sušenja, čvrstoći i krutosti postoje veće razlike.The physical properties of plaster bandages are a very important factor in achieving the basic functions of ­immobilization (maintaining bone fragments in the best possible position), which directly affects the speed and quality of fracture healing. This paper compares the differences between the physical properties of plaster bandages (mass, specific weight, drying rate, elasticity and strength) and records the differences in plaster modeling of fast bonding 10 cm wide plaster bandages, from three different manufacturers: Safix plus (Hartmann, Germany), Cellona (Lohman Rauscher, Austria) and Gipsan (Ivo Lola Ribar ltd., Croatia). Plaster tiles from ten layers of plaster, dimension 10 x 10 cm were made. The total number of tiles from each manufacturer was 48. The water temperature of 22 °C was used for the first 24 tiles and 34 °C was used for the remainder. The average specific weight of the original packaging was: Cellona (0.52 g/cm3), Gipsan (0.50 g/cm3), Safix plus (0.38 g / cm3). Three days after plaster tile modeling an average specific weight of the tiles was: Gipsan (1.15 g/cm3), Safix plus (1.00 g/cm3), Cellona (1.10 g/cm3). The average humidity of 50% for Safix plus and ­Cellona plaster tiles was recorded 18 hours after modeling, while for the Gipsan plaster tiles, this humidity value was seen after 48 hours. On the third day after plaster modeling the average humidity of the plaster tiles was 30% for Gipsan, 24% for Safix and 16% for Cellona. Cellona plaster tiles made with 34 °C water achieved the highest elasticity (11.75±3.18 MPa), and Gipsan plaster tiles made with 22 °C had the lowest (7.21±0.9 MPa). Cellona plaster tiles made with 34 °C water showed maximum material strength (4390±838 MPa), and Gipsan plaster tiles made with 22 °C water showed the lowest material strength (771±367 MPa). The rigidity and strength of Cellona and Gipsan plaster are higher in tiles made in warmer water, and for Safix plus are higher in tiles made in cooler water. All three types of plaster differentiate in physical properties. The differences in mass and specific weight before and after plaster modeling are minimal. There are greater differences in ­drying rate, elasticity and strength between the three different plaster material

PHYSICAL PROPERTIES OF PLASTER BANDAGES

Fizikalna svojstva sadrenih zavoja bitan su čimbenik u ostvarenju osnovne funkcije sadrenih imobilizacija (zadržavanje ulomaka kosti u dobrom položaju), a time izravno utječu na brzinu i kvalitetu cijeljenja prijeloma. U ovom radu mjere se fizikalna svojstva (masa, specifična težina, brzina sušenja, krutost i čvrstoća) i bilježe razlike sadrenog ­postupka, brzovežućih sadrenih zavoja širine 10 cm triju različitih proizvođača: Safix plus (Hartmann, Njemačka), Cellona (Lohman Rauscher, Austrija) i Gipsan (Ivo Lola Ribar d. o. o., Hrvatska). Sadreno je deset slojeva zavoja u pločice dimenzija 10 × 10 cm. Od svakog proizvoda načinjene su 24 pločice sadrene u vodi temperature 22 °C i isto toliko u vodi temperature 34 °C. Prosječna specifična težina originalnog pakiranja zavoja bila je: Cellona 0,52 g/cm3, Gipsan 0,50 g/cm3, Safix plus 0,38 g/cm3. Tri dana nakon sadrenja prosječna specifična težina pločica bila je: Gipsan 1,15 g/cm3, Safix plus 1,00 g/cm3, Cellona 1,10 g/cm3. Prosječna vlažnost od 50% pločicâ Safix i Cellona trajala je 18 sati, a pločicâ Gipsan 48 sati nakon sadrenja. Treći dan nakon sadrenja prosječna vlažnost pločica Gipsan bila je 30%, Safixa 24%, a Cellone 16%. Najveću krutost imale su pločice sadrenog zavoja Cellona sadrene vodom temperature 34 °C (11,75 ± 3,18 MPa), a najma­nju (7,21 ± 0,9 MPa) pločice sadrenog zavoja Gipsan sadrene vodom temperature 22 °C. Sadreni zavoj Cellona, sadren vodom temperature 34 °C, pokazuje najveću čvrstoću materijala (4390 ± 838 MPa), a najmanju (771 ± 367 MPa) pločice sadrenog zavoja Gipsan sadrene vodom temperature 22 °C. Sadrenjem zavoja Cellona i Gipsan u toplijoj vodi (34 °C) pločice su bile veće krutosti i čvrstoće. Pločice Safix plus nemaju ovo svojstvo. Sve tri vrste sadrenih zavoja razlikuju se prema fizikalnim svojstvima. S obzirom na masu i specifičnu težinu prije i nakon sadrenja razlike su minimalne. Prema brzini sušenja, čvrstoći i krutosti postoje veće razlike.The physical properties of plaster bandages are a very important factor in achieving the basic functions of ­immobilization (maintaining bone fragments in the best possible position), which directly affects the speed and quality of fracture healing. This paper compares the differences between the physical properties of plaster bandages (mass, specific weight, drying rate, elasticity and strength) and records the differences in plaster modeling of fast bonding 10 cm wide plaster bandages, from three different manufacturers: Safix plus (Hartmann, Germany), Cellona (Lohman Rauscher, Austria) and Gipsan (Ivo Lola Ribar ltd., Croatia). Plaster tiles from ten layers of plaster, dimension 10 x 10 cm were made. The total number of tiles from each manufacturer was 48. The water temperature of 22 °C was used for the first 24 tiles and 34 °C was used for the remainder. The average specific weight of the original packaging was: Cellona (0.52 g/cm3), Gipsan (0.50 g/cm3), Safix plus (0.38 g / cm3). Three days after plaster tile modeling an average specific weight of the tiles was: Gipsan (1.15 g/cm3), Safix plus (1.00 g/cm3), Cellona (1.10 g/cm3). The average humidity of 50% for Safix plus and ­Cellona plaster tiles was recorded 18 hours after modeling, while for the Gipsan plaster tiles, this humidity value was seen after 48 hours. On the third day after plaster modeling the average humidity of the plaster tiles was 30% for Gipsan, 24% for Safix and 16% for Cellona. Cellona plaster tiles made with 34 °C water achieved the highest elasticity (11.75±3.18 MPa), and Gipsan plaster tiles made with 22 °C had the lowest (7.21±0.9 MPa). Cellona plaster tiles made with 34 °C water showed maximum material strength (4390±838 MPa), and Gipsan plaster tiles made with 22 °C water showed the lowest material strength (771±367 MPa). The rigidity and strength of Cellona and Gipsan plaster are higher in tiles made in warmer water, and for Safix plus are higher in tiles made in cooler water. All three types of plaster differentiate in physical properties. The differences in mass and specific weight before and after plaster modeling are minimal. There are greater differences in ­drying rate, elasticity and strength between the three different plaster material

FRONTAL, AXILLARY AND TYMPANIC TEMPERATURE MEASUREMENTS IN CHILDREN

Svrha ovoga prospektivnog istraživanja, provedenog u jednom istraživačkom centru, bila je usporediti vrijednosti tjelesne temperature izmjerene dvjema metodama: standardnim staklenim termometrom u aksilarnoj regiji i infracrvenim temperaturama timpanične i frontalne regije u afebrilne djece. Studija obuhvaća 345-ero afebrilne djece životne dobi od 4 do 16 godina, koja su radi elektivnog zahvata boravila na odjelu dječje kirurgije. Temperature su mjerene u 1000 navrata simultano aksilarno, u slušnom kanalu i frontalno. Koristili smo se dvama različitim infracrvenim termometrima; jednom vrstom za timpaničnu, drugom za frontalnu temperaturu. Aksilarna temperatura definirana je kao standard i mjerena je klasičnim staklenim termometrom. Svaki je pacijent bio izložen konstantnoj temperaturi okoliša minimalno 10 minuta prije simultanog mjerenja temperatura. Prosječna frontalna temperatura bila je 36,9 ± 0,38 °C i jednaka je aksilarnoj tempera­turi, 36,9 ± 0,16 °C. Prosječna timpanična temperatura bila je 36,3 ± 0,98 °C. Srednja je razlika timpanične i aksilarne temperature –0,4 °C. Izmjereni niz timpaničnih temperatura u skupini naših ispitanika ima trostruko veću disperziju nego frontalni niz i pet puta veću nego aksilarne temperature. Aksilarne temperature, mjerene klasičnim staklenim termometrom, imaju najmanju disperziju izmjerenih vrijednosti, slijede frontalne temperature mjerene infracrvenim termometrom, a najmanje su pouzdane izmjerene timpanične temperature.The purpose of this study was to compare the results of body temperature measurements obtained by standard axillary thermometers with the results of infrared tympanic and frontal skin thermometry in afebrile children. This study comprises a single-center, prospective comparison trial. A total of 345 afebrile children aged 4 to 16 years hospitalized in the pediatric surgery department for elective surgery were included. One thousand axillary, tympanic and frontal measurements were obtained and compared. We used two different infrared thermometers in this study; one type measured the tympanic temperature, the other the temperature on the forehead. The axillary temperature measured with the glass thermometer was set as the standard. Each patient was exposed to a constant environmental temperature for a minimum of 10 min before simultaneous temperature measurements. The mean frontal temperature 36.9± 0.38 °C was equal to the axillary temperature 36.9± 0.16 °C. The mean tympanic temperature was 36.3 ± 0.98 °C. The mean difference between the tympanic and axillary temperatures was –0.4 °C. The tympanic temperature had a threefold greater dispersion than frontal and a fivefold greater dispersion than axillary temperature. The results of this study suggest that the axillary temperature measured with glass thermometer has the least dispersion. Somewhat less reliable is the frontal temperature measured with infrared thermometer. The least reliable is tympanic temperature measurement

Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595