Intramedullary Nailing of Paediatric Tibial Fractures : Comparison between Flexible and Rigid Nails

Purpose: To describe patient characteristics and to compare outcomes of children undergoing rigid intramedullary nailing of tibial fractures as compared with those operated on using elastic intramedullary nailing. Methods: A retrospective review of 26 children who have undergone flexible intramedullary nailing of tibial fractures and 30 children with rigid nailing at our university hospital between 2008 and 2017. The patient charts and radiographs were evaluated to identify demographic characteristics and several variables were measured preoperatively, as well as 6-12 weeks postoperatively in addition to final follow-up radiographs. Results: Twenty-six patients (26/26, 100%) treated with a flexible nail and 14 patients (14/30, 46.7%) treated with a rigid nail had open proximal tibial physis (p <0.001). An acceptable postoperative alignment was obtained in 20 patients (20/26, 76.9%) in the elastic stable intramedullary nail group and in 29 patients (29/30, 96.7%) in the rigid group (p = 0.026). Some complications occurred in four patients (4/26, 15%) in the elastic stable intramedullary nail population and seven patients (7/30, 23%) in the rigid intramedullary nail population (p = 0.46). Malunion occurred in six patients (6/26, 23%) in the elastic stable intramedullary nail group and in none of the patients treated with a rigid intramedullary nail (p = 0.005). Conclusion: Younger children with tibial fractures who weight 50 kg or less and with proximal tibial growth plates wide open can be treated with elastic stable intramedullary nail while more mature adolescents benefit from rigid intramedullary nailing.Peer reviewe

A QCD analysis for nuclear PDFs at NNLO

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Treatment strategies for early-onset scoliosis

Early-onset scoliosis (EOS) is defined as a spinal deformity occurring before the age of ten years.Untreated EOS or early spinal fusion resulting in a short spine is associated with increased mortality and cardiopulmonary compromise.EOS may progress rapidly, and therefore prompt clinical diagnosis and referral to a paediatric orthopaedic or spine unit is necessary.Casting under general anaesthesia can be effective and may prevent or delay the need for surgery in curves of less than 60°.‘Growing’ rods (traditional or magnetically-controlled) represent the standard surgical treatment in progressive curves of 45° or greater.Children with congenital scoliosis associated with fused ribs benefit from surgery with a vertical titanium prosthetic rib.Surgery with growth-friendly instrumentation is associated with a high risk of complications.</li

Constraints for nuclear PDFs from the LHCb D-meson data

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”Se voidaan ratkaista hiljaisella keskustelulla julkisen väittelyn sijaan”:Malesian etniset kysymykset The Straits Times -sanomalehdessä vuosina 1965–1969

Tiivistelmä. Pro gradu -tutkielman aiheena on Malesian etnisistä kysymyksistä käyty julkinen keskustelu vuosina 1965–1969. Tutkielman lähdeaineistona käytettiin singaporelaislähtöistä englanninkielistä The Straits Times -sanomalehteä. Analysoin tutkielmassa, missä yhteyksissä ja miten etnisistä kysymyksistä keskusteltiin. Tämän lisäksi selvitin, mitä etnisten kysymysten käsittely kertoi Malesian poliittisen eliitin pyrkimyksistä luoda yhtenäinen kansakunta. Tarve yhtenäistää kansaa oli kova, sillä Malesia oli vuoden 1957 itsenäistymisen yhteydessä perinyt Ison-Britannian siirtomaahallinnon aikana muodostuneen monietnisen väestön, joka oli karkeasti sanottuna jakautunut taloudellisesti hyvin toimeentuleviin kiinalaisiin ja vähempiosaisiin, mutta poliittisessa valta-asemassa oleviin malaijeihin. Tutkielma on mediahistoriaa ja poliittista historiaa. Metodisesti hyödynsin aineistolähtöistä sisällönanalyysia eli analysoin etnisistä kysymyksistä käytyä keskustelua niissä yhteyksissä, missä sanomalehti nosti ne esille. The Straits Times oli yksi Malesian yhteiskunnallisen ja poliittisen keskustelun foorumi. Vaikka sanomalehdessä seurattiin poliittista keskustelua näinnäisen puolueettomasti, saivat hallituksessa olleet puolueet eniten näkyvyyttä lehden sivuilla. Lehdistön vapautta rajoittaneet lait, asetukset ja lehden harjoittama itsesensuuri vaikuttivat myös The Straits Timesin tapaan käsitellä poliittisesti arkoja etnisiä kysymyksiä kuten kielipolitiikkaa. Tutkimusajanjakson aikana etnisiä kysymyksiä käsiteltiin The Straits Timesissa poliittisen päätöksenteon ja poliittisen kilpailun yhteyksissä. Myös monet yhteiskunnalliset kriisit kuten Singaporen ero Malesian liittovaltiosta vuonna 1965, Penangin osavaltiossa puhjenneet mellakat vuonna 1967 ja vuoden 1969 parlamenttivaalien jälkeiset mellakat nostivat etniset kysymykset julkisen keskustelun keskiöön. Malesian malaijijohtoinen hallitus pyrki yhtenäistämään monietnistä kansaa yhteisen identiteetin, malesialaisuuden, avulla. The Straits Timesissa käydyistä keskusteluista ilmeni, että malesialaisuutta tulkittiin monella tavalla. Hallitukselle malesialaisuus merkitsi lähes samaa kuin malaijilaisuus kun taas monet oppositiopuolueet näkivät malesialaisuudessa mahdollisuuden monietniselle kansallisidentiteetille. Nämä ristiriidat ja The Straits Timesissa ylläpidetyt siirtomaa-aikaiset stereotyyppiset kuvaukset Malesian etnisistä ryhmistä johtivat osaltaan 1960-luvulla etnisten malaijien ja kiinalaisten välisiin väkivaltaisiin yhteenottoihin. Tämä tutkielma pyrkii täydentämään historiantutkimuksen antamaa kuvaa postkolonialistisesta Malesiasta ja sen sisällä käydyistä etnisiin kysymyksiin liittyneistä keskusteluista, mihin The Straits Times tarjosi lähdeaineistona uudenlaisen näkökulman

Paediatric supracondylar humeral fractures: the effect of the surgical specialty on the outcomes

Purpose The effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.Methods A retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.Results Residents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).Conclusion We found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.Level of evidence: Level II

Treatment of Aneurysmal Bone Cysts with Bioactive Glass in Children

Background and Aims: Aneurysmal bone cysts represent about 1% of primary bone tumors. The standard treatment is curettage, followed by local adjuvant treatments and bone grafting. The problem is the high recurrence rate. The purpose of this study was to evaluate retrospectively the use of bioactive glass as a filling material in the treatment of aneurysmatic bone cysts in children. Material and Methods: A total of 18 consecutive children (mean 11.3years at surgery; 10 males; 11 lower, 6 upper limb, 1 pelvis; 15 with primary surgery) with histologically proven primary aneurysmal bone cysts operated with curettage and bioactive glass filling between 2008 and 2013 were evaluated after a mean follow-up of 2.0years (range, 0.7-5.1years). Results: Two (11%) patients showed evidence of aneurysmal bone cyst recurrence and both have been re-operated for recurrence. Bone remodeling was noted in all patients with remaining growth and no growth plate disturbances were recorded. Two patients needed allogeneic blood transfusion. No intraoperative or postoperative complications were recorded. Conclusion: We conclude that bioactive glass is a suitable filling material for children with primary aneurysmal bone cyst. Bioactive glass did not affect bone growth and no side effects were reported.Peer reviewe

Hospital admissions and surgical treatment of children with lower-limb deficiency in Finland

Background and Aims: There are no population-based studies about hospital admissions and need for surgical treatment of congenital lower-limb deficiencies. The aim is to assess the impact children with lower-limb deficiencies pose to national hospital level health-care system. Materials and Methods: A population-based study was conducted using the national Register of Congenital Malformations and Care Register for Health Care. All 185 live births with lower-limb deficiency (1993-2008) were included. Data on hospital care were collected until 31 December 2009 and compared to data on the whole pediatric population (0.9 million) live born in 1993-2008. Results: The whole pediatric population had annually on average 0.10 hospital admissions and the mean length of in-patient care of 0.3 days per child. The respective figures were 1.5 and 5.6 in terminal lower-limb amputations (n = 7), 1.1 and 3.9 in long-bone deficiencies (n = 53), 0.6 and 1.9 in foot deficiencies (n = 26) and 0.4 and 2.6 in toe deficiencies (n = 101). Orthopedic surgery was performed in 72% (5/7) of patients with terminal amputations, in 62% (33/53) of patients with long bone, in 58% (14/24) of patients with foot and in 25% (25/101) of patients in toe deficiencies. Half (54%) of all procedures were orthopedic operations. Conclusion: In congenital lower-limb deficiencies the need of hospital care and the number of orthopedic procedures is multiple-fold compared to whole pediatric population. The burden to the patient and to the families is markedly increased, especially in children with terminal amputations and long-bone deficiencies of lower limbs.Peer reviewe

Instrumented cervical spinal fusions in children: indications and outcomes

　 PurposeTo report indications, outcomes and complications of instrumented cervical spinal fusion in a consecutive series of children at major university hospitals.MethodsA retrospective, single surgeon series identified 35 consecutive children with a mean follow-up (FU) of 2.5 years undergoing instrumented cervical spinal fusion between 2005 and 2015.ResultsThe main indications were skeletal dysplasia and trauma associated cervical instability. Surgical complications were observed in 12 (34%) patients with multiple complications in four (11%). Four (11%) children required at least one revision surgery, three for nonunion and one for graft dislodgement. All were fused at FU. Surgical complications were more common in children undergoing occipitocervical (OC) fusion than in those avoiding fusion of the OC junction (60% versus 24%) (p = 0.043). Complications were found significantly more in children operated on under the age of ten years than above (50% versus 18%) (p = 0.004). The risk of complications was not dependent on the indications for surgery (skeletal dysplasia versus trauma) (p = 0.177),ConclusionSkeletal dysplasia associated cervical instability and cervical spine injuries represented the most common indications for instrumented cervical spinal fusion in children. Complications were observed in one-third of these children and 11% required revision surgery for complications. OC spinal fusion and spinal fusion before the age of ten years are associated with higher risk of surgical complications and increased mortality than non-OC fusions and cervical spinal fusions at an older age. We urge surgeons to employ caution to the patient, timing and procedure selection when treating paediatric cervical spine. </p

Centrality and rapidity dependence of inclusive pion and prompt photon production in p + Pb collisions at the LHC with EPS09s nPDFs

Volume: 589The centrality dependencies of the inclusive neutral pion and prompt photon nuclear modification factors for p+Pb collisions at the LHC are studied using a spatially dependent set of nuclear PDFs, EPS09s. The calculations are performed at mid- and forward rapidities searching for an observable which would optimally probe the spatial dependence of the nuclear PDFs. In addition, we discuss to which $x$ values of the nucleus the different observables are sensitive.Peer reviewe