پژوهشگران جوان علوم زیستی- دانشگاه آزاد رودهن (Biology young researcher club- Islamic Azad University, Roudehen Branch.)
زندگی فاصله آمدن و رفتن ماست, شاید آن خنده كه امروز دریغش كردی، آخرین فرصت همراهی ماست.
- Discuss the effect of head injury on outcome of the multiply injured pediatric patient
- Discuss the orthopaedic assessment of the head injured child or adolescent
- Discuss management of fractures associated with the head injured patient
- Describe problems other than fracture associated with head injury
- What factors contribute to the exuberant callus formation in head injured patients?
- What care does the child with fractures and a head injury need after hospital discharge?
Severe head injury is the most devastating childhood injury. Recent
reports indicate the mortality of severe head injury in children is
nearly the same as for adults, and residual disability is common.
Multiple injuries, including fractures, often accompany severe
head injury, which is generally the result of a motor vehicle accident.
In children less than 2 years of age, abuse remains a common
causative factor, especially for subdural hematoma, and completely for
retinal hemorrhage. There is general agreement that rigid fixation of
fractures, either external or internal, facilitates care. It is
not so clear whether outcome is changed by early fixation, in fact one
recent report suggest early fixation of fractures may contribute to a
worse neurologic result. Hemorrhage is less often a factor
in children's pelvic fractures than adults, mortality was exclusively a
result of head injury. In general, the severity of head injury is
related to outcome.
Recognition of extremity or pelvic fractures can be difficult in
the comatose patient. Bone scintigraphy has been found to have a
reasonable yield in identifying unrecognized fractures.
Procrastination in management of fractures is most wisely avoided, as
many children will again ambulate even after several weeks of coma.
Peripheral nerve injury is another injury recognized
late, and Gillogly reported late peripheral neuropathy in 19/ 122
patients with severe head injury unassociated with extremity injury;
all had severe spasticity. Other complications include
heterotopic ossification and/ or exuberant callus following fracture.
Serum from head injured patients has been identified as having an
increased quantity of growth factors, which may
contribute to bone formation in anatomic sites not generally predisposed
to ossification. To further complicate the diagnostic picture, venous
thrombosis has been reported in a limb coexisting with
heterotopic ossification. Late resection of heterotopic ossification can
restore motion and function, results appear to be enhanced with
administration of indomethacin or salicylates. Spasticity can be
very difficult. Fractures in spastic limbs obviously require some type
of rigid fixation, external fixation is most often used at present.
Management of spasticity in the head injured patient can
include splinting and casting, in conjunction with agents such as
botulinus toxin or phenol which do not have a permanent effect.
A recent follow-up study by Greenspan noted that needed physical and/ or
occupational therapy and mental health services were often not
prescribed after discharge. Careful follow-up by
knowledgeable professionals was recommended. The head injured child
presents many challenges in the acute phase (recognition and treatment
of fractures), the subacute phase (spasticity), and the
chronic phase (rehab, heterotopic ossification, and maximizing function).
- Bidner SM, Rubins IM, Desjardins JV, Zukor DJ, Goltzman D.
Evidence for a humoral mechanism for enhanced osteogenesis after head
injury. Journal of Bone & Joint Surgery - American Volume 1990; 72( 8): 1144-9.
- Dashti SR, Decker DD, Razzaq A, Cohen AR. Current patterns of inflicted head injury in
children. Pediatric Neurosurgery 1999; 31( 6): 302-6.
- Feickert HJ, Drommer S, Heyer R. Severe head injury in
children: impact of risk factors on outcome. Journal of Trauma-Injury
Infection & Critical Care 1999; 47( 1): 33-8.
- Gillogly SD, Gross RH. Orthopaedic problems in head injured children and adolescents. Ortho Trans 1987; 11: 43.
- Greenspan AI, MacKenzie EJ. Use and need for post-acute services
following paediatric head injury. Brain Injury 2000; 14( 5): 417-29.
- Heinrich SD, Gallagher D, Harris M, Nadell JM. Undiagnosed fractures
in severely injured children and young adults. Identification with
technetium imaging. Journal of Bone & Joint Surgery -American Volume 1994; 76( 4): 561-72.
- Ippolito E, Formisano R, Caterini R, Farsetti P, Penta F. Operative
treatment of heterotopic hip ossification in patients with coma after
brain injury. Clinical Orthopaedics & Related Research 1999( 365): 130-8.
- Jaicks RR, Cohn SM, Moller BA. Early fracture fixation may be deleterious after head injury.
Journal of Trauma-Injury Infection & Critical Care 1997; 42( 1):
1-5; discussion -6.
- Johnson DL, Krishnamurthy S. Severe pediatric head injury:
myth, magic, and actual fact. Pediatric Neurosurgery 1998; 28( 4):167-72.
- Kotwica Z, Balcewicz L, Jagodzinski Z. Head injuries coexistent with
pelvic or lower extremity fractures--early or delayed osteosynthesis.
Acta Neurochirurgica 1990; 102( 1-2): 19-21.
- Mital MA, Garber JE, Stinson JT. Ectopic bone formation in children
and adolescents with head injuries: its management. Journal of
Pediatric Orthopedics 1987; 7( 1): 83-90.
- Musemeche CA, Fischer RP, Cotler HB, Andrassy RJ. Selective
management of pediatric pelvic fractures: a conservative approach.
Journal of Pediatric Surgery 1987; 22( 6): 538-40.
- On AY, Kirazli Y, Kismali B, Aksit R. Mechanisms of action of phenol
block and botulinus toxin Type A in relieving spasticity:
electrophysiologic investigation and follow-up. American Journal of Physical Medicine & Rehabilitation 1999; 78( 4): 344-9.
- Philip PA, Philip M. Peripheral nerve injuries in children with traumatic brain injury. Brain Injury 1992; 6( 1): 53-8.
- Poole GV, Miller JD, Agnew SG, Griswold JA. Lower extremity fracture
fixation in head-injured patients. Journal of Trauma-Injury Infection
& Critical Care 1992; 32( 5): 654-9.
- Schmeling GJ, Schwab JP. Polytrauma care. The effect of head
injuries and timing of skeletal fixation. Clinical Orthopaedics &
Related Research 1995( 318): 106-16.
- Sferopoulos NK, Anagnostopoulos D. Ectopic bone formation in a child
with a head injury: complete regression after immobilisation.
International Orthopaedics 1997; 21( 6): 412-4.
- Sobus KM, Sherman N, Alexander MA. Coexistence of deep venous
thrombosis and heterotopic ossification in the pediatric patient.
Archives of Physical Medicine & Rehabilitation 1993; 74( 5): 547-51.
- Spencer RF. The effect of head injury on fracture healing. A
quantitative assessment. Journal of Bone & Joint Surgery -British
Volume 1987; 69( 4): 525-8.
- Tolo VT. External fixation in multiply injured children. Orthop Clin North Am 1990; 21: 393-400.
- Townsend RN, Lheureau T, Protech J, Riemer B, Simon D. Timing
fracture repair in patients with severe brain injury (Glasgow Coma
Scale score <9) [see comments]. Journal of Trauma-Injury Infection & Critical Care 1998; 44( 6): 977-82; discussion 82-3.
نوشته شده در جمعه 4 دی 1388 ساعت
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