Intermittent claudications of the hand after supracondylar humeral fracture in a 2-year old boy

Supracondylar humeral fractures (SHF) are the most common fractures associated with concomitant neurovascular injuries in children. Pink pulseless hand (PPH) labels SHF presenting without a pulse in a wellperfused hand. Management of PPH after successful SHF reduction remains controversial. Some advocate „watchful waiting”, whereas others favor early exploration. We present a case of a 2-year-old boy with PPH and intermittent claudications 6 weeks after successful SHF reduction

Mechanisms of humerus fractures in children of Zagreb

Zbog nespretnosti, nepažnje i neiskustva prijelomi nadlaktične kosti u djece su vrlo česti. U dobi do 7 godina, ovi prijelomi su najčešći od svih prijeloma. Cilj ovoga rada je analizirati uzroke prijeloma, mjesta gdje nastaju te aktivnosti koje doprinose povećanju rizika nastanka prijeloma. Analizirano je 243 djece liječenih u KBC-u Zagreb zbog prijeloma nadlaktične u kosti u razdoblju od 2015. do 2019. godine. Najviše djece se ozljeđivalo u dobi od 5 – 9 godina s vrhom incidencije u sedmoj godini života. Češće su se ozljeđivali dječaci od djevojčica te je češće bila slomljena lijeva ruka. Najčešće se lomila distalna trećina nadlaktične kosti u obliku suprakondilarnog prijeloma. U većini slučajeva radilo se o nestabilnom prijelomu te je bilo potrebno kirurško liječenje. Glavna mjesta gdje su se prijelomi dogodili bili su športske i atletske površine, zatim nešto rjeđe kod kuće te u školi i na ulici. Značajna mjesta prijeloma su dječja igrališta gdje se ističu ljuljačke i tobogani. Kao sport s najviše prijeloma nadlaktične kosti ističe se nogomet. Iako većina prijeloma u djece završava bez gubitka funkcije, prijelomi u djece dovode do drugih vrsta problema. Stres hospitalizacije i kirurškog liječenja, izbivanje iz škole i smanjenje aktivnosti tjednima ili čak mjesecima samo su neki od njih. Bolničko liječenje i kasniji kontrolni pregledi stvaraju određeni trošak za bolnicu. Uzimajući u obzir veliku učestalost prijeloma zbog padova s ljuljačke, tobogana, trampolina i ostalih sprava u parkovima i dječjim igralištima valjalo bi prilikom gradnje novih ili unaprjeđivanja starijih igrališta dati veći značaj pitanju sigurnosti i ublažavanja eventualnih padova, a sve to s ciljem prevencije prijeloma i drugih težih ozljeda.As a result of clumsiness, carelessness and inexperience, fractures of the upper arm in children are very common. By the age of 7, these fractures are the most common of all fractures. The aim of this paper is to analyze causes of fractures, places where they occur and activities that contribute to increasing the risk of fractures of the humerus. The paper analyzed 243 children, treated at the University Hospital Center in Zagreb for fractures of the upper arm in the period from 2015 to 2019. Most injuries occured between the age of 5 and 9 with a peak incidence at the age of 7. Boys were injured more often than girls. Left arm was broken more frequently than right with distal third being the most often broken part of humerus. In most cases, it was an unstable fracture and it requiered surgical treatment. The main places where the fractures occurred were sports and athletic fields, somewhat less frequently at home, at school and on the street. Significant places of fracture are children's playgrounds where swings and slides stand out as the biggest risk contributors. Football stands out as the sport with the most fractures of the upper arm bone. Although most fractures in children heal without loss of function, fractures in children lead to other types of problems. The stress of hospitalization and surgical treatment, being absent from school and reduced activity for weeks or even months are just some of them. Hospital treatment and subsequent check-ups generate, also, a certain cost for the hospital. Considering the high frequency of fractures due to falls from swings, slides, trampolines and other devices in parks and children's playgrounds, when building new or upgrading older playgrounds, greater importance should be given to the issue of safety and mitigation of possible falls in order to prevent fractures and other serious injuries

Mechanisms of humerus fractures in children of Zagreb

Zbog nespretnosti, nepažnje i neiskustva prijelomi nadlaktične kosti u djece su vrlo česti. U dobi do 7 godina, ovi prijelomi su najčešći od svih prijeloma. Cilj ovoga rada je analizirati uzroke prijeloma, mjesta gdje nastaju te aktivnosti koje doprinose povećanju rizika nastanka prijeloma. Analizirano je 243 djece liječenih u KBC-u Zagreb zbog prijeloma nadlaktične u kosti u razdoblju od 2015. do 2019. godine. Najviše djece se ozljeđivalo u dobi od 5 – 9 godina s vrhom incidencije u sedmoj godini života. Češće su se ozljeđivali dječaci od djevojčica te je češće bila slomljena lijeva ruka. Najčešće se lomila distalna trećina nadlaktične kosti u obliku suprakondilarnog prijeloma. U većini slučajeva radilo se o nestabilnom prijelomu te je bilo potrebno kirurško liječenje. Glavna mjesta gdje su se prijelomi dogodili bili su športske i atletske površine, zatim nešto rjeđe kod kuće te u školi i na ulici. Značajna mjesta prijeloma su dječja igrališta gdje se ističu ljuljačke i tobogani. Kao sport s najviše prijeloma nadlaktične kosti ističe se nogomet. Iako većina prijeloma u djece završava bez gubitka funkcije, prijelomi u djece dovode do drugih vrsta problema. Stres hospitalizacije i kirurškog liječenja, izbivanje iz škole i smanjenje aktivnosti tjednima ili čak mjesecima samo su neki od njih. Bolničko liječenje i kasniji kontrolni pregledi stvaraju određeni trošak za bolnicu. Uzimajući u obzir veliku učestalost prijeloma zbog padova s ljuljačke, tobogana, trampolina i ostalih sprava u parkovima i dječjim igralištima valjalo bi prilikom gradnje novih ili unaprjeđivanja starijih igrališta dati veći značaj pitanju sigurnosti i ublažavanja eventualnih padova, a sve to s ciljem prevencije prijeloma i drugih težih ozljeda.As a result of clumsiness, carelessness and inexperience, fractures of the upper arm in children are very common. By the age of 7, these fractures are the most common of all fractures. The aim of this paper is to analyze causes of fractures, places where they occur and activities that contribute to increasing the risk of fractures of the humerus. The paper analyzed 243 children, treated at the University Hospital Center in Zagreb for fractures of the upper arm in the period from 2015 to 2019. Most injuries occured between the age of 5 and 9 with a peak incidence at the age of 7. Boys were injured more often than girls. Left arm was broken more frequently than right with distal third being the most often broken part of humerus. In most cases, it was an unstable fracture and it requiered surgical treatment. The main places where the fractures occurred were sports and athletic fields, somewhat less frequently at home, at school and on the street. Significant places of fracture are children's playgrounds where swings and slides stand out as the biggest risk contributors. Football stands out as the sport with the most fractures of the upper arm bone. Although most fractures in children heal without loss of function, fractures in children lead to other types of problems. The stress of hospitalization and surgical treatment, being absent from school and reduced activity for weeks or even months are just some of them. Hospital treatment and subsequent check-ups generate, also, a certain cost for the hospital. Considering the high frequency of fractures due to falls from swings, slides, trampolines and other devices in parks and children's playgrounds, when building new or upgrading older playgrounds, greater importance should be given to the issue of safety and mitigation of possible falls in order to prevent fractures and other serious injuries

Mechanisms of humerus fractures in children of Zagreb

Zbog nespretnosti, nepažnje i neiskustva prijelomi nadlaktične kosti u djece su vrlo česti. U dobi do 7 godina, ovi prijelomi su najčešći od svih prijeloma. Cilj ovoga rada je analizirati uzroke prijeloma, mjesta gdje nastaju te aktivnosti koje doprinose povećanju rizika nastanka prijeloma. Analizirano je 243 djece liječenih u KBC-u Zagreb zbog prijeloma nadlaktične u kosti u razdoblju od 2015. do 2019. godine. Najviše djece se ozljeđivalo u dobi od 5 – 9 godina s vrhom incidencije u sedmoj godini života. Češće su se ozljeđivali dječaci od djevojčica te je češće bila slomljena lijeva ruka. Najčešće se lomila distalna trećina nadlaktične kosti u obliku suprakondilarnog prijeloma. U većini slučajeva radilo se o nestabilnom prijelomu te je bilo potrebno kirurško liječenje. Glavna mjesta gdje su se prijelomi dogodili bili su športske i atletske površine, zatim nešto rjeđe kod kuće te u školi i na ulici. Značajna mjesta prijeloma su dječja igrališta gdje se ističu ljuljačke i tobogani. Kao sport s najviše prijeloma nadlaktične kosti ističe se nogomet. Iako većina prijeloma u djece završava bez gubitka funkcije, prijelomi u djece dovode do drugih vrsta problema. Stres hospitalizacije i kirurškog liječenja, izbivanje iz škole i smanjenje aktivnosti tjednima ili čak mjesecima samo su neki od njih. Bolničko liječenje i kasniji kontrolni pregledi stvaraju određeni trošak za bolnicu. Uzimajući u obzir veliku učestalost prijeloma zbog padova s ljuljačke, tobogana, trampolina i ostalih sprava u parkovima i dječjim igralištima valjalo bi prilikom gradnje novih ili unaprjeđivanja starijih igrališta dati veći značaj pitanju sigurnosti i ublažavanja eventualnih padova, a sve to s ciljem prevencije prijeloma i drugih težih ozljeda.As a result of clumsiness, carelessness and inexperience, fractures of the upper arm in children are very common. By the age of 7, these fractures are the most common of all fractures. The aim of this paper is to analyze causes of fractures, places where they occur and activities that contribute to increasing the risk of fractures of the humerus. The paper analyzed 243 children, treated at the University Hospital Center in Zagreb for fractures of the upper arm in the period from 2015 to 2019. Most injuries occured between the age of 5 and 9 with a peak incidence at the age of 7. Boys were injured more often than girls. Left arm was broken more frequently than right with distal third being the most often broken part of humerus. In most cases, it was an unstable fracture and it requiered surgical treatment. The main places where the fractures occurred were sports and athletic fields, somewhat less frequently at home, at school and on the street. Significant places of fracture are children's playgrounds where swings and slides stand out as the biggest risk contributors. Football stands out as the sport with the most fractures of the upper arm bone. Although most fractures in children heal without loss of function, fractures in children lead to other types of problems. The stress of hospitalization and surgical treatment, being absent from school and reduced activity for weeks or even months are just some of them. Hospital treatment and subsequent check-ups generate, also, a certain cost for the hospital. Considering the high frequency of fractures due to falls from swings, slides, trampolines and other devices in parks and children's playgrounds, when building new or upgrading older playgrounds, greater importance should be given to the issue of safety and mitigation of possible falls in order to prevent fractures and other serious injuries

Mehanizam nastanka prijeloma nadlaktične kosti zagrebačke djece

Prijelomi humerusa vrlo su česti. Većinom zahtijevaju bolničko liječenje, prate ih komplikacije i loši ishodi. Smanjenje pojavnosti prevencijom moguće je poznavanjem mehanizama nastanka prijeloma. Mehanizam nastanka uvjetovan je tjelesnim aktivnostima, životnom dobi i socijalnim okruženjem. U radu se analiziraju uzroci, aktivnosti i mjesta nastanka prijeloma humerusa u zagrebačke djece. Od 2015. do 2019. godine u KBC-u Zagreb zbog prijeloma nadlaktične kosti liječeno je 301 dijete, a u radu je analizirano 243 djece. Bilo je 143 dječaka (58,8%) i 100 djevojčica (41,2%). Prosječna starost bila je 7,5 godina, dječaka 7,9, a djevojčica 7,0 godina. Najviše djece, njih 147 (60,5%) bilo je u dobi od 5 do 9 godina. Češće je lomljena lijeva ruka (62%). Od 243 djece, njih 22 (9%) zadobilo je prijelom gornjeg, petero (2%) srednjeg i 216 (88%) donjeg dijela nadlaktične kosti. Bolnički je liječeno 223 (91,8%) djece s prijelomom humerusa. Druge teške ozljede imalo je 29 (12%) djece (6% ozljeda ulnarnog i po 3% medinusa i radijalnog živca). Uzrok prijeloma u 224 (92,2%) djece bio je pad, prometne nesreće u 5 (2,1%), a u 3 (1,2%) djece prijelom je nastao zbog direktnog udarca. Od svih prijeloma padom u razini, njih 22,4% su padovi s bicikla i 13% u igri nogometa. Kod padova s bicikla najčešća su djeca dobne skupine 5–9 godina (60%). Kod padova s male visine najčešći su pad s ljuljačke, s tobogana i trampolina (60%). S tobogana i trampolina padaju djeca predškolske dobi, a s ljuljačke u svim dobnim skupinama. Kod kuće nastaje četvrtina svih prijeloma (26,7%), na rekreacijskim terenima 28,8%, u školi 14,4%, a u prometu 14%. U zagrebačke djece najčešći mehanizmi ozljede su pad u istoj razini (kod vožnje bicikla i u igri nogometa) te padovi s male visine (trampolin, tobogan, ljuljačka).Humeral fractures in children are very common. In most cases hospital treatment is necessary, with complications and poor outcome sometimes occurring. To reduce the incidence of humeral fractures, it is necessary to know the mechanisms of injury and circumstances in which they occur. The aim of this paper is to analyze activities and locations related to humeral fracture occurrences. The paper analyzed 243 children treated at the University Hospital Center Zagreb for fractures of the upper arm in the period from 2015 to 2019. There were 143 (58.8%) boys and 100 (41.2%) girls. Mean age was 7.5 years (boys 7.9, girls seven years). Most children, 147 (60.5%) of them, were between ages five and nine. Left-sided fractures were more common (62%). Of 243 humeral fractures, 22 (9%) were proximal fractures, five (2%) were shaft fractures, and 216 (88%) were located in the distal humerus. Hospitalization was required in 223 patients (91.8%). Associated nerve injuries were present in 29 (12%) patients (ulnar nerve 6%, median nerve 3%, radial nerve 3%). The fractures were caused by falling in 224 patients (92.2%), traffic accident in five patients (2.1%), and direct blow in three patients (1.2%). Of same level falls, 22.4% were falls of bicycle and 13% occurred while playing football. Falls of bicycle were most common in children between ages five and nine (60%). Falls from height mostly occur from swing, slide and trampoline (60%), with falls from slide and trampoline being more common in pre-school children, and falls from swing occurring in all age groups. Injuries occurred at home in 26.7% of patients, on sports/recreation grounds in 28.8%, at school in 14.4%, and in traffic in 14% of children. The most common causes of injury were same level falls (from bicycle and during football), and falls from height (swing, slide, and trampoline)

Initial results of microsurgical varicocele treatment in boys and adolescents

SAŽETAK Cilj: prikazati metodu i rane ishode prvih 20 dječaka i adolescenata kod kojih je učinjena mikrokirurška varikokelektomija na Zavodu za dječju kirurgiju Kliničkoga bolničkog centra Zagreb. Ova metoda prema literaturnim podatcima ima najmanju učestalost recidiva i komplikacija. Ispitanici i metode: Indikacije za mikrokiruršku operaciju jesu simptomatska varikokela, hipotrofija testisa (zahvaćeni testis volumno manji od zdravog za >20%), te poremećaj spermiograma kod adolescenata u završnom (Tanner 5) stadiju spolnog razvoja. Varikokela i hipotrofija testisa utvrđeni su kliničkim pregledom, ultrazvučnom volumetrijom i dopplerskim pregledom. Operacija se izvodi kroz rez duljine 3 – 4 cm u razini vanjskoga ingvinalnog otvora. Pacijenti su praćeni prospektivno nakon operacije, a prosječno vrijeme praćenja bilo je deset mjeseci (raspon 6 – 12 mjeseci). Rezultati: Prosječno trajanje operacije bilo je 65 minuta. Svi pacijenti su otpušteni kući unutar 24 sata od operacije, a vratili su se svim aktivnostima unutar dva tjedna nakon operacije. Tijekom kontrolnih pregleda nije zabilježen recidiv varikokele, kod svih pacijenata koji su operirani zbog simptoma došlo je do nestanka tegoba, dok je kod onih koji su operirani zbog lošeg spermiograma došlo do oporavka ejakulata. Od komplikacija, jedan pacijent je imao prolaznu nelagodu kod ejakulacije. Kod jednog pacijenta je intraoperativno neželjeno podvezana testikularna arterija koja je odmah rekonstruirana termino-terminalnom anastomozom uz uredne protoke na kontrolnim dopplerskim pregledima sjemenskog snopa, bez znakova atrofije testisa. Zaključak: Mikrokirurška varikokelektomija je sigurna metoda za liječenje varikokele sa visokom uspješnošću i malim brojem komplikacija.SUMMARY Aim: To describe the surgical technique and present outcomes of the first 20 boys and adolescents that underwent microsurgical varicocelectomy at the Department of pediatric surgery, University Hospital Center Zagreb. According to the literature data, this method has the lowest incidence of recurrence and complications. Patients and Methods: Indications for microsurgical varicocelectomy are the same as for other methods of varicocele treatment: presence of symptoms, testicular hypotrophy (affected testicle smaller >20% in volume compared to the contralateral testicle), or abnormal semen analysis in adolescent that reached the final (Tanner 5) stage of pubertal development. The diagnoses of varicocele and testicular hypotrophy were established by clinical examination, ultrasound volumetry and Doppler examination. The surgery was done through a 3–4 cm incision above the external inguinal ring. The patients were followed prospectively, with an average follow-up of 10 months (range 6–12 months). Results: Average surgery duration was 65 minutes. All patients were discharged within 24 hours after surgery, and returned to all preoperative activities within two weeks postoperatively. No recurrences were noted during follow-up, symptoms resolved in all patients operated for symptomatic varicocele, and sperm count normalized in all patients that underwent surgery for abnormal semen analysis. Regarding complications, one patient reported a transitory discomfort during ejaculation. In one patient the testicular artery was inadvertently ligated during surgery, but was immediately reconstructed with an end-to-end anastomosis. Control Doppler examinations of the spermatic cord showed a patent anastomosis with normal flow. Conclusion: Microsurgical varicocelectomy is a safe method for varicocele treatment with a high success rate and low incidence of complications