Publications by authors named "Willy Serlo"

65 Publications

Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children's Forearm Shaft Fractures with at Least Four Years of Follow-Up.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Department of Children and Adolescents/Pediatric Surgery and Orthopedics, PEDEGO Research Center, Oulu University Hospital, 90029 Oulu, Finland.

The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN ( = 19) or ESIN ( = 16). Forearm rotation at minimally four years' follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.
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http://dx.doi.org/10.3390/jcm10050995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957875PMC
March 2021

Efficacy of the implementation of the National Emergency X-Radiography Utilization Study (NEXUS) II decision rule to clinical practice for pediatric head injury patients.

Acta Paediatr 2021 Mar 28. Epub 2021 Mar 28.

PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University hospital, University of Oulu, Oulu, Finland.

Aim: To investigate the usefulness of the National Emergency X-Radiography Utilization Study (NEXUS) II head trauma decision rule in clinical practice for pediatric patients in a tertiary university hospital serving as the only pediatric hospital in the area.

Methods: We compared how doctors evaluated and examined patients with head injury during two time periods; before and after the introduction of NEXUS II decision rule. Multiple implementation strategies were used: education, tutoring and written instructions for the use of NEXUS II.

Results: 244 head injury patients visited the hospital before and 385 after the introduction of the NEXUS II decision rule. The number of hospital admissions (56%) and the mean duration of hospitalization (2.5d) remained the same during the two periods. In the NEXUS II evaluated group, there was a decrease of 40% in the number of hospital admissions. NEXUS II was applied in only 62 (16%) cases. The number of head imaging procedures remained the same. No patients with a clinically significant head injury were missed with the NEXUS II evaluation.

Conclusion: NEXUS II was ineffective as our implementation failed. When used, NEXUS II reduced expenses in our study population by decreasing the number of hospital admissions.
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http://dx.doi.org/10.1111/apa.15859DOI Listing
March 2021

A single genetic locus associated with pediatric fractures: A genome-wide association study on 3,230 patients.

Exp Ther Med 2020 Aug 12;20(2):1716-1724. Epub 2020 Jun 12.

Department of Children and Adolescents, Oulu Childhood Fracture and Sports Injury Study, Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO), Oulu Medical Research Center (MRC), University of Oulu and Oulu University Hospital, FI-90029 Oulu, Finland.

The understanding of the biological and environmental risk factors of fractures in pediatrics is limited. Previous studies have reported that fractures involve heritable traits, but the genetic factors contributing to the risk of fractures remain elusive. Furthermore, genetic influences specific to immature bone have not been thoroughly studied. Therefore, the aim of the present study was to identify genetic variations that are associated with fractures in early childhood. The present study used a prospective Northern Finland Birth Cohort (year 1986; n=9,432). The study population was comprised of 3,230 cohort members with available genotype data. A total of 48 members of the cohort (1.5%) had in-hospital treated bone fractures during their first 6 years of life. Furthermore, individuals without fracture (n=3,182) were used as controls. A genome-wide association study (GWAS) was performed using a frequentist association test. In the GWAS analysis, a linear regression model was fitted to test for additive effects of single-nucleotide polymorphisms (SNPs; genotype dosage) adjusting for sex and performing population stratification using genotypic principal components. Using the GWAS analysis, the present study identified one locus with a significant association with fractures during childhood on chromosome 10 (rs112635931) and six loci with a suggested implication. The lead SNP rs112635931 was located near proline- and serine-rich 2 (PROSER2) antisense RNA 1 (PROSER2-AS1) and PROSER2, thus suggesting that these may be novel candidate genes associated with the risk of pediatric fractures.
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http://dx.doi.org/10.3892/etm.2020.8885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388260PMC
August 2020

Maternal alcohol consumption during pregnancy associates with bone fractures in early childhood. A birth-cohort study of 6718 participants.

Bone 2020 08 30;137:115462. Epub 2020 May 30.

Department of Pediatric Surgery and Orthopaedics, Oulu University Hospital, PEDEGO-research unit and Medical Research Center, University of Oulu, Oulu, Finland.

Fractures are common injuries in children, but their underlying biological and environmental risk factors are not well known. Maternal alcohol consumption during pregnancy is a known risk factor for bone malformations and impaired growth, in connection with Fetal Alcohol Spectrum Disorders (FASD). There is evidence that even lower doses of alcohol than what is needed for FASD can cause changes in the developing bone. Birth weight and length may also associate to childhood fractures. The aim of this study was to find out whether there exist associations between maternal alcohol use during pregnancy, birth weight or length and fractures of the long bones in childhood. A prospective birth cohort was performed, including all women in Northern Finland with an expected date of delivery between July 1985 and June 1986, and their offspring (N = 9432). The National Hospital Discharge Register (NHDR) provided the information on inpatient treated fractures. The subjects who declined participation or were treated as outpatient were excluded. The final study population consisted of 6718 children (71.2%). 98 (1.5%) of them suffered from inpatient treated fracture of a long bone (N = 105). Maternal alcohol consumption during pregnancy was inquired by questionnaires during late pregnancy or shortly after parturition. The birth length and weight were recorded immediately after birth. Binomial regression analysis was used to determine the association between the potential explanatory variables and bone fractures. Gender, socioeconomic status of the family, maternal age, premature birth, body mass index (BMI) of the children and maternal smoking during pregnancy were taken as possible confounders. In this study, the maternal alcohol consumption during pregnancy was associated to 2.22-fold (CI 1.09-4.12, p < 0.02) increased risk of a long bone fracture before the age of eight. Birth weight or length did not associate to childhood fractures. Bone fractures are an important cause of morbidity in childhood. Their prevention should start from the prenatal period by protecting the fetus from the alcohol exposure.
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http://dx.doi.org/10.1016/j.bone.2020.115462DOI Listing
August 2020

Biomaterial and implant induced ossification: in vitro and in vivo findings.

J Tissue Eng Regen Med 2020 08 8;14(8):1157-1168. Epub 2020 Jul 8.

International Clinical Research Center of St. Anne's University Hospital Brno, Brno, Czech Republic.

Material-induced ossification is suggested as a suitable approach to heal large bone defects. Fiber-reinforced composite-bioactive glasses (FRC-BGs) display properties that could enhance the ossification of calvarial defects. Here, we analyzed the healing processes of a FRC-BG implant in vivo from the perspective of material-induced ossification. Histological analysis of the implant, which was removed 5 months after insertion, showed the formation of viable, noninflammatory mesenchymal tissue with newly-formed mineralized woven bone, as well as nonmineralized connective tissue with capillaries and larger blood vessels. The presence of osteocytes was detected within the newly generated bone matrix. To expand our understanding on the osteogenic properties of FRC-BG, we cultured human adipose tissue-derived mesenchymal stromal cells (AD-MSCs) in the presence of two different BGs (45S5 and S53P4) and Al O control. AD-MSCs grew and proliferated on all the scaffolds tested, as well as secreted abundant extracellular matrix, when osteogenic differentiation was appropriately stimulated. 45S5 and S53P4 induced enhanced expression of COL2A1, COL10A1, COL5A1 collagen subunits, and pro-osteogenic genes BMP2 and BMP4. The concomitant downregulation of BMP3 was also detected. Our findings show that FRC-BG can support the vascularization of the implant and the formation of abundant connective tissue in vivo. Specifically, BG 45S5 and BG S53P4 are suited to evoke the osteogenic potential of host mesenchymal stromal cells. In conclusion, FRC-BG implant demonstrated material-induced ossification both in vitro and in vivo.
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http://dx.doi.org/10.1002/term.3056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496445PMC
August 2020

Trampoline-related proximal tibia impaction fractures in children: a population-based approach to epidemiology and radiographic findings between 2006 and 2017.

J Child Orthop 2020 Apr;14(2):125-131

Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital and PEDEGO research group, MRC Oulu, Oulu University, Oulu, Finland.

Purpose: Proximal tibia impaction fractures are specific injuries, usually caused by trampolining. They may associate with later growth disturbances. There is sparse understanding about their recent epidemiology, in particular the changing incidence. Their typical radiographic findings are not completely known.

Methods: All children, aged < 16 years, who had suffered from proximal tibia fracture in Oulu Arc and Oulu between 2006 and 2017 were enrolled (n = 101). Their annual incidence was determined using the official population-at-risk, obtained from the Statistics Finland. The specific characteristics and risk factors of the patients and their fractures were evaluated. Radiographic findings were analyzed, in particular the anterior tilting of the proximal growth plate, due to impaction.

Results: The annual incidence increased two-fold from 9.5 per 100 000 children (2006 to 2009) to 22.0 per 100 000 (2014 to 2017) (difference: 12.5; 95% confidence interval 5.1 to 20.3 per 100 000; p = 0.0008). The mean annual incidence of trampoline impaction leg fractures was 15.4 per 100 000 children. In 80% of the cases multiple children had been jumping together on the trampoline. Anterior tilting (mean 7.3°, SD 2.5°, 6.1° to 19.1°) ) of the proximal tibial plate was seen in 68.3% of the patients. Satisfactory bone union was found in 92.7% during follow-up. Isolated patients presented delayed bone healing.

Conclusion: The incidence of trampoline leg fractures has increased 130% during the 12 years of the study period. Many of these injuries could have been prevented by avoiding having several jumpers on the trampoline at the same time. Anterior tilting of the growth plate was a common finding and should be recognized in the primary radiographs.

Level Of Evidence: IV.
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http://dx.doi.org/10.1302/1863-2548.14.190177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184643PMC
April 2020

The incidence and treatment trends of pediatric proximal humerus fractures.

BMC Musculoskelet Disord 2019 Nov 27;20(1):571. Epub 2019 Nov 27.

Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, PoB 23, 90029 OYS, Oulu, Finland.

Background: Proximal humerus fractures comprise approximately 2% of all pediatric fractures. In general, upper extremity fractures have increased in children. However, recent trends of proximal humerus fractures are not analyzed yet. The aim was to study the incidence and treatment trends of proximal humerus fractures in children.

Methods: All 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 2005 and 2015, were included. Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time.

Results: The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%, P = 0.045). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8-51.4, P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. Higher age was also associated with operative treatment (P = 0.002). The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining.

Conclusion: Contrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear.
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http://dx.doi.org/10.1186/s12891-019-2948-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882178PMC
November 2019

Interventional magnetic resonance imaging as a diagnostic and therapeutic method in treating acute pediatric atlantoaxial rotatory subluxation.

Exp Ther Med 2019 Jul 9;18(1):18-24. Epub 2019 May 9.

Department of Children and Adolescents, Oulu University Hospital, Oulu 90220, Finland.

Atlantoaxial rotatory subluxation or fixation (AARF) is a rare condition, usually occurring in pediatric patients. It mimics benign torticollis but may result in permanent disability or death. The condition requires prompt diagnosis by thorough examination to avoid any treatment delays. Spiral computed tomography (CT) with three-dimensional reconstruction CT is recommended for identifying incongruence between C1 and C2 vertebrae, and magnetic resonance imaging (MRI) may be performed to exclude ligamentous injuries. In addition to static imaging, dynamic CT involves the reduction between C1 and C2 being confirmed using CT with the head turned maximally to the left and right. The present report (level of evidence, III) provides a method for treating AARF that has similar advantages as dynamic CT but avoids ionizing radiation by replacing CT with interventional MRI. The new method comprised simultaneous axial traction and manual closed reduction, performed under general anesthesia, and the use of interventional MRI to ensure that reduction was achieved and held. The head is turned maximally to the right and left during the manual reduction. A rigid cervical collar was used following reduction. Dynamic CT was not required but prior diagnostic static CT was performed in preparation. No further CT was required. There appears to be no previous studies on interventional MRI in AARF care. Being superior in its diagnostic soft-tissue visualization performance and lacking ionizing radiation, interventional MRI is a potential option for investigating and treating acute AARF in non-syndromic patients with no trauma history.
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http://dx.doi.org/10.3892/etm.2019.7565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566071PMC
July 2019

Recent trends in children's elbow dislocation with or without a concomitant fracture.

BMC Musculoskelet Disord 2019 Jun 19;20(1):294. Epub 2019 Jun 19.

Department of Children and Adolescents Pediatric Surgery and Orthopedics Oulu University Hospital, Medical Research Centre Oulu and PEDEGO Research, Group Oulu University, PO Box 23, 90029 OYS, Oulu, Finland.

Background: The elbow is the joint that most usually dislocates in children. In contrast to the widely known recent increase in the incidence of upper-extremity fractures and their operative treatment in children, potential trends in elbow dislocation are not clear. In this study we aimed to clarify the recent epidemiology of childhood elbow dislocation, in particular the potential change in incidence and treatment.

Methods: A population-based study was performed to evaluate the annual incidence and the characteristics of injury, patients and treatment. All children < 16 years of age with an elbow dislocation in 1996-2014 in the Oulu University Hospital District, Finland, were included. Elbow dislocations with and without an associated fracture were included. The mean number of children in the population at risk was 85,600, according Statistics Finland.

Results: There were 104 patients with a mean age of 11.3 years (SD 2.6). The annual incidence was 6.4 (mean) per 100,000 children in 1996-2014 and no changing trend in incidence during the study period was found. Trampoline jumping was the most usual reason for the dislocations (N = 15, 14.4%). The majority (N = 73/104, 70.2%) were treated non-operatively by reduction and casting. There was no change in surgical treatment during the study time.

Conclusion: In contrast to increasing incidence of upper-extremity fractures in children, there has not been a change in the incidence of elbow dislocation in children. There was no change in surgical treatment in 1996-2014.
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http://dx.doi.org/10.1186/s12891-019-2651-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582483PMC
June 2019

Non-union of the ulnar styloid process in children is common but long-term morbidity is rare: a population-based study with mean 11 years (9-15) follow-up.

Acta Orthop 2019 08 4;90(4):383-388. Epub 2019 Apr 4.

a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital , Oulu ;

Background and purpose - Fracture of the ulnar styloid process (USP) is common in children in connection with distal radius fracture. The long-term morbidity of USP non-union following a childhood distal radius fracture is unclear. We evaluated long-term clinical and radiographic findings of USP non-union. Patients and methods - All 208 children (< 16 years) who had suffered from distal radius fracture with or without a diagnosed concomitant ulnar fracture during 1992-1999 in the study institution were invited to follow-up at mean of 11 years (9-15) after the injury. Radiographs of both wrists of all 139 participants (67%) were taken; 22 patients showed USP non-union and they made up the study population. Distal radioulnar joint (DRUJ) instability, decreased range of motion (ROM), and weakened grip strength as compared with the uninjured side were the main functional outcomes. Elements of the "Disability of Arm, Shoulder and Hand" questionnaire were used for subjective symptoms. Results - The rate of USP non-union following childhood distal forearm fracture was 16% (22/139) and only 9 of the ulnar styloid fractures were visible in the radiographs primarily. At follow-up wrist flexion-extension ROM and ulnar and radial deviation ranges did not differ between the injured and uninjured sides. Grip strengths were similar. 6 patients reported pain during exercise. 7 had ulna minus (mean 2.3 mm) but none showed degenerative radiographic findings. Interpretation - The long-term clinical results of USP non-union following a childhood wrist fracture were good. However, one-third of the patients with USP non-union had ulnar shortening, which may predispose them to degenerative processes later in life.
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http://dx.doi.org/10.1080/17453674.2019.1596561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718181PMC
August 2019

Experience with resorbable sonic pins for the attachment of distraction devices in posterior cranial vault distraction operations.

Childs Nerv Syst 2019 05 8;35(5):851-856. Epub 2019 Mar 8.

Medical Research Center, Oulu University Hospital, Oulu, Finland.

Background: Distraction techniques are effective methods for the treatment of craniosynostoses when a significant gain of an intracranial volume is required. However, this technique raises some challenges at different stages of the treatment. While installing the distractors in patients with thin calvarial bone, there is a risk of dural damage from the titanium screws. The need for wide exposure of the devices and the screws during removal causes soft tissue damage and bleeding.

Objective: This study aimed to evaluate sonic pin use in the distraction procedures.

Methods: Resorbable sonic pins were used in 11 consecutive posterior cranial vault distraction procedures to attach distraction devices to the calvarial bone.

Results: This method allowed for a less traumatic and faster removal of the devices without the risk of leaving foreign bodies in the wound. In three out of 11 cases on follow-up, displacement of proximal distractor footplate and partial relapse of distraction were detected. Though there was a smaller volume increase in these patients, all of them benefited clinically from the PCVD and did not require reoperations.

Conclusions: This method allows a strong and stable attachment of the distractor devices to the cranial vault bones with a reduced risk of dural tears due to the screws. It also allows for easier and less traumatic device removal.
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http://dx.doi.org/10.1007/s00381-019-04097-0DOI Listing
May 2019

A large calvarial bone defect in a child: osteointegration of an implant.

World Neurosurg 2019 Jan 23. Epub 2019 Jan 23.

Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; PO Box 23, 90029 OYS, Finland; Medical Research Center Oulu, and PEDEGO Research Unit, University of Oulu, Oulu, Finland.

Background: This is an original report describing the long-term follow-up outcome of a cranioplasty. A large calvarial bone defect of a child was reconstructed with a bioactive and biostable non-metallic implant.

Case Description: This is a case study of a young child with an infantile fibrosarcoma of occipital bone. The malignancy in an occipital bone was removed from a child of 2.5 years of age, and the defect site was reconstructed with an on-lay glass fibre-reinforced composite - bioactive glass implant. After 5 years and 7 months, the follow-up examination showed no signs of a recidive. During the follow-up period, the contour of the reconstructed area followed skull anatomical development. Computed tomography demonstrated considerably large areas (approximately 70 % of the total area) of bone on-growth to the peridural surface of the implant.

Conclusions: In the future, a synthetic cranioplasty material that is capable to integrate with cranial bone may be considered superior to cryopreserved bone grafts in younger age groups.
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http://dx.doi.org/10.1016/j.wneu.2019.01.028DOI Listing
January 2019

Classification of bone flap resorption after cranioplasty: a proposal for a computed tomography-based scoring system.

Acta Neurochir (Wien) 2019 03 14;161(3):473-481. Epub 2019 Jan 14.

Department of Neurosurgery, Oulu University Hospital, Kajaanintie 52, 90029, Oulu, Finland.

Background: Bone flap resorption (BFR) is the most prevalent complication resulting in autologous cranioplasty failure, but no consensus on the definition of BFR or between the radiological signs and relevance of BFR has been established. We set out to develop an easy-to-use scoring system intended to standardize the interpretation of radiological BFR findings.

Methods: All 45 autologous cranioplasty patients operated on at Oulu University Hospital from 2004 to 2014 were identified, and the bone flap status of all the available patients was evaluated using the new scoring system. Derived from previous literature, a three-variable score for the detection of BFR changes is proposed. The variables "Extent" (estimated remaining bone volume), "Severity" (possible perforations and their measured diameter), and "Focus" (the number of BFR foci within the flap) are scored from 0 to 3 individually. Using the sum of these scores, a score of 0-9 is assigned to describe the degree of BFR. Additionally, independent neurosurgeons assessed the presence and relevance of BFR from the same data set. These assessments were compared to the BFR scores in order to find a score limit for relevant BFR.

Results: BFR was considered relevant by the neurosurgeons in 11 (26.8%) cases. The agreement on the relevance of BFR demonstrated substantial strength (κ 0.64, 95%CI 0.36 to 0.91). The minimum resorption score in cases of relevant BFR was 5. Thus, BFR with a resorption score ≥ 5 was defined relevant (grades II and III). With this definition, grade II or III BFR was found in 15 (36.6%) of our patients. No risk factors were found to predict relevant BFR.

Conclusions: The score was proven to be easy to use and we recommend that only cases with grades II and III BFR undergo neurosurgical consultation. However, general applicability can only be claimed after validation in independent cohorts.
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http://dx.doi.org/10.1007/s00701-018-03791-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407745PMC
March 2019

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up.

Biomaterials 2018 12 11;185:383-392. Epub 2018 Sep 11.

Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland.

There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN. A randomized, controlled clinical trial included patients, aged 5-15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes. Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied.
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http://dx.doi.org/10.1016/j.biomaterials.2018.09.011DOI Listing
December 2018

Predictors of primary autograft cranioplasty survival and resorption after craniectomy.

J Neurosurg 2018 May 1:1-8. Epub 2018 May 1.

6Department of Biomaterials Science, Institute of Dentistry, University of Turku and City of Turku, Welfare Division, Turku.

OBJECTIVECraniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption.METHODSThe authors identified all patients who underwent primary autologous cranioplasty at 3 tertiary-level university hospitals between 2002 and 2015. Patients underwent follow-up until bone flap removal, death, or December 31, 2015.RESULTSThe cohort comprised 207 patients with a mean follow-up period of 3.7 years (SD 2.7 years). The overall complication rate was 39.6% (82/207), the bone flap removal rate was 19.3% (40/207), and 11 patients (5.3%) died during the follow-up period. Smoking (OR 3.23, 95% CI 1.50-6.95; p = 0.003) and age younger than 45 years (OR 2.29, 95% CI 1.07-4.89; p = 0.032) were found to independently predict subsequent autograft removal, while age younger than 30 years was found to independently predict clinically relevant bone flap resorption (OR 4.59, 95% CI 1.15-18.34; p = 0.03). The interval between craniectomy and cranioplasty was not found to predict either bone flap removal or resorption.CONCLUSIONSIn this large, multicenter cohort of patients with autologous cranioplasty, smoking and younger age predicted complications leading to bone flap removal. Very young age predicted bone flap resorption. The authors recommend that physicians extensively inform their patients of the pronounced risks of smoking before cranioplasty.
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http://dx.doi.org/10.3171/2017.12.JNS172013DOI Listing
May 2018

Cranioplasty After Severe Traumatic Brain Injury: Effects of Trauma and Patient Recovery on Cranioplasty Outcome.

Front Neurol 2018 9;9:223. Epub 2018 Apr 9.

Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland.

Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known.

Objective: We sought to investigate if injury- and treatment-related factors, and state of recovery could predict the risk of major complications in cranioplasty requiring implant removal, and how these complications affect the outcome.

Methods: A retrospective cohort of 40 patients with DC following sTBI and subsequent cranioplasty was studied. Non-injury-related factors were compared with a reference population of 115 patients with DC due to other conditions.

Results: Outcome assessed 1 day before cranioplasty did not predict major complications leading to implant removal. Successful cranioplasty was associated with better outcome, whereas a major complication attenuates patient recovery: in patients with favorable outcome assessed 1 year after cranioplasty, major complication rate was 7%, while in patients with unfavorable outcome the rate was 42% ( = 0.003). Of patients with traumatic subarachnoid hemorrhage (tSAH) on admission imaging 30% developed a major complication, while none of patients without tSAH had a major complication ( = 0.014). Other imaging findings, age, admission Glasgow Coma Scale, extracranial injuries, length of stay at intensive care unit, cranioplasty materials, and timing of cranioplasty were not associated with major complications.

Conclusion: A successful cranioplasty after sTBI and DC predicts favorable outcome 1 year after cranioplasty, while stage of recovery before cranioplasty does not predict cranioplasty success or failure. tSAH on admission imaging is a major risk factor for a major complication leading to implant removal.
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http://dx.doi.org/10.3389/fneur.2018.00223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904383PMC
April 2018

Outcomes of 40 Nonsyndromic Sagittal Craniosynostosis Patients as Adults: A Case-Control Study With 26 Years of Postoperative Follow-up.

Oper Neurosurg (Hagerstown) 2019 01;16(1):1-8

Medical Research Centre, Oulu University Hospital, Oulu, Finland.

Background: While sagittal synostosis is the most common craniosynostosis, long-term follow-up of these patients is lacking.

Objective: To evaluate the results of surgical management of those patients with sagittal synostosis who attain adulthood.

Methods: An outcome study of surgically treated isolated sagittal synostosis patients operated between 1977 and 1998 was conducted at the Craniofacial Center of Oulu University Hospital, Oulu, Finland with an average follow-up time of 26.5 yr. Patients' socioeconomic situation, satisfaction with their own facial appearance and attractiveness as rated by 2 independent panels was evaluated and compared to controls.

Results: The self-satisfaction with the patients' own appearance scored a mean of 75 mm on a visual analog scale of 100 mm between the patients and 76 mm with the control group. The subjective satisfaction of the patients with their own appearance failed to correlate with the rating of their appearance by the panels. The panels rated the patients' appearance to be on average 6 to 7 mm out of 100 mm visual analog scale less attractive than the controls. Data on socioeconomic situation, including marital status, housing, education, employment of the patients, and controls are presented.

Conclusion: Isolated sagittal synostosis patients treated surgically were as happy with their facial appearance as were individuals in an age and gender-matched control group. Two independent panels found the patients' appearance to be only somewhat less attractive. Analysis of the socioeconomic situation and general health revealed that patients equaled that of controls.
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http://dx.doi.org/10.1093/ons/opy047DOI Listing
January 2019

Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy.

J Neurosurg 2018 02;130(1):312-321

1Department of Neurosurgery, Oulu University Hospital.

OBJECTIVE: Autologous bone cranioplasty after decompressive craniectomy entails a notable burden of difficult postoperative complications, such as infection and bone flap resorption (BFR), leading to mechanical failure. The prevalence and significance of asymptomatic BFR is currently unclear. The aim of this study was to radiologically monitor the long-term bone flap survival and bone quality change in patients undergoing autologous cranioplasty. METHODS: The authors identified all 45 patients who underwent autologous cranioplasty at Oulu University Hospital, Finland, between January 2004 and December 2014. Using perioperative and follow-up CT scans, the volumes and radiodensities of the intact bone flap prior to surgery and at follow-up were calculated. Relative changes in bone flap volume and radiodensity were then determined to assess cranioplasty survival. Sufficient CT scans were obtainable from 41 (91.1%) of the 45 patients. RESULTS: The 41 patients were followed up for a median duration of 3.79 years (25th and 75th percentiles = 1.55 and 6.66). Thirty-seven (90.2%) of the 41 patients had some degree of BFR and 13 (31.7%) had a remaining bone flap volume of less than 80%. Patients younger than 30 years of age had a mean decrease of 15.8% in bone flap volume compared with the rest of the cohort. Bone flap volume was not found to decrease linearly with the passing of time, however. The effects of lifestyle factors and comorbidities on BFR were nonsignificant. CONCLUSIONS: In this study BFR was a very common phenomenon, occurring at least to some degree in 90% of the patients. Decreases in bone volume were especially prominent in patients younger than 30 years of age. Because the progression of resorption during follow-up was nonlinear, routine follow-up CT scans appear unnecessary in monitoring the progression of BFR; instead, clinical follow-up with mechanical stability assessment is advised. Partial resorption is most likely a normal physiological phenomenon during the bone revitalization process.
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http://dx.doi.org/10.3171/2017.8.JNS171857DOI Listing
February 2018

Severe Trampoline Injuries: Incidence and Risk Factors in Children and Adolescents.

Eur J Pediatr Surg 2018 Dec 22;28(6):529-533. Epub 2017 Nov 22.

Department of Children and Adolescents Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland.

Introduction:  Severe trampoline injuries in children and adolescents are rare; however, minor injuries are common and their incidence is increasing. Severe injuries are most commonly head and neck injuries. They may result in long-term morbidity. This study aimed to illustrate these severe injuries and to find out their incidence and risk factors.

Materials And Methods:  This is a population-based, prospective study in the Oulu region of Finland completed over 2 years (May 1, 2015 to April 31, 2017). All children (<16 years of age) with severe trampoline injuries were included. Cervical spine fractures, chest wall and skull fractures, lesions of internal organs, hip and knee dislocations, and permanent disorders of the peripheral veins or nerves were in prior defined as severe. Multiple jumpers, stunts, younger age, previous injuries, insufficient use of safety equipment, and lack of supervision were hypothesized as risk factors.

Results:  There were 11 injured patients (10 boys). The annual incidence was 6.28/100,000 children <16 years of age. Mean age was 11.5 years. Severe injuries included five ligamentous cervical spine injuries and two sternal bone fractures. In addition, there were one lumbar spine ligament injury, two hip dislocations, and one severe axillary plexus nerve lesion. Eight out of 11 accidents were not seen by any adult and none of them happened under professional supervision. Most injuries ( = 8) happened by failed backflips.

Conclusion:  Most severe injuries happened in unsuccessful flips. Children should have an adult supervisor and flips should not be attempted.
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http://dx.doi.org/10.1055/s-0037-1608676DOI Listing
December 2018

Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study.

Eur J Orthop Surg Traumatol 2018 Apr 20;28(3):423-429. Epub 2017 Nov 20.

Sports Injury Research Center, Hospital NEO, Turku, Finland.

Introduction: Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes.

Materials And Methods: Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up.

Results: Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes.

Conclusions: Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery.

Level Of Evidence: Case series, IV.
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http://dx.doi.org/10.1007/s00590-017-2074-xDOI Listing
April 2018

Maternal smoking during pregnancy is associated with childhood bone fractures in offspring - A birth-cohort study of 6718 children.

Bone 2017 Aug 4;101:202-205. Epub 2017 May 4.

Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

In children there is limited understanding about the biological and environmental risk factors of fractures. Therefore, we aimed to study the effect of maternal smoking on preschool children's fractures hypothesizing that the fracture risk might be programmed during intrauterine growth in means of disturbed bone formation. A prospective birth cohort included women living in Northern Finland with an expected date of delivery between July 1st, 1985 and June 30th, 1986 (N=9362), and their offspring (N=9432). Smoking was inquired during pregnancy and when the offspring reached seven years of age. Information on in-hospital-treated fractures among the children was collected from the National Hospital Discharge Register (NHDR). The cases who declined to participate or suffered from any bone dysplasia such as osteogenesis imperfecta or any malignancy were excluded, thus 6718 subjects (71.2%) were finally included. Poisson regression analysis with adjustment for gender, asthma, rheumatoid arthritis, socioeconomic status of the family, maternal age and body mass index (BMI) of the children was used to determine the association between maternal smoking during pregnancy and bone fractures. Maternal smoking during pregnancy was associated with a 1.83-fold (95% CI 1.06-3.02, p=0.022) increased risk of in-hospital-treated fractures at pre-school age. The fracture risk in childhood is perhaps increased as a result of modified bone development of the fetus due to maternal smoking.
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http://dx.doi.org/10.1016/j.bone.2017.05.007DOI Listing
August 2017

Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls.

Int Orthop 2017 07 8;41(7):1453-1461. Epub 2017 Apr 8.

Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu University, Medical Research Center Oulu, PEDEGO Research Group, P.o. BOX 23, FIN-90029 OYS, Oulu, Finland.

Introduction: Lateral humeral condylar fractures are the second most common elbow fractures in children. We present the long-term clinical and radiographic results.

Material And Methods: All children (<16 years) in the geographic catchment area with lateral condylar fracture were asked to participate and 32 (76.2%) patients enrolled. Clinical and functional results are compared with randomly selected but age and sex matched normal controls at 12.4 years (range 10.6 to 16.0).

Results: Unsatisfactory clinical outcomes were found in 40.6% of the fracture cases vs. 6.3% controls (P = 0.003), according to Flynn's criteria. Flexion-extension range of motion was decreased >5° in 13 cases (40.6%) and in four controls (12.5%, P = 0.013). One in four (N = 8, 25%) of the cases showed cubitus varus >5° and 15.7% (N = 5) had cubitus valgus >5°, compared to one cubitus valgus (3.1%) in controls (P = 0.002).

Conclusion: The majority of the adolescent and young adult patients (59.4%) with a previous paediatric lateral humeral condylar fracture had recovered well and showed good or excellent overall outcomes according to Flynn's criteria for elbow assessment after a mean of 12.4 years post-injury. Long-term sequelae was unchanged regardless of treatment.
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http://dx.doi.org/10.1007/s00264-017-3451-0DOI Listing
July 2017

Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases.

Neurosurgery 2017 Nov;81(5):803-811

Medical Research Center, Oulu University Hospital, Oulu, Finland.

Background: Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume.

Objective: To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs.

Methods: All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow-up. In 5 patients, additional 3-D photogrammetric imaging was done pre- and postoperatively.

Results: The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3-D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups.

Conclusion: PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.
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http://dx.doi.org/10.1093/neuros/nyx125DOI Listing
November 2017

Biodegradable poly-L-lactide-co-glycolide copolymer pin fixation of a traumatic patellar osteochondral fragment in an 11-year-old child: A novel surgical approach.

Exp Ther Med 2017 Jan 29;13(1):242-246. Epub 2016 Nov 29.

Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, 90029 OYS, Finland.

Treating displaced patellar bone fractures in growing children remains a challenge for orthopedic surgeons. Removal of loose bone fragments may prolong healing time and result in early onset osteoarthrosis. Therefore, primary fixation of osteochondral fragments is preferred. Metallic pin and screw implants are typically used for fixation, as there is little evidence available regarding the use of modern biodegradable implants in traumatic patellar fractures of a premature skeleton. The present report describes a novel operative technique using headless poly-L-lactide-co-glycolide (PLGA) pins in treating an 11-year-old girl with a patellar fracture from a cycling injury. The surgical technique of this procedure is described in detail in the current report. Excellent subjective outcomes were achieved from this surgery, with superb bone healing according to follow-up radiographic and computerized tomography scans. In conclusion, the results of this case indicate that, similarly to osteochondritis, intra-articular osteochondral fractures in children may be fixed using biodegradable PLGA pins. Randomized clinical trials should be performed to confirm this finding and evaluate the use of PLGA pins as a treatment for adolescent osteochondral fractures.
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http://dx.doi.org/10.3892/etm.2016.3934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245126PMC
January 2017

Gartland Type II Supracondylar Humerus Fractures, Their Operative Treatment and Lateral Pinning Are Increasing: A Population-Based Epidemiologic Study of Extension-Type Supracondylar Humerus Fractures in Children.

Eur J Pediatr Surg 2017 Oct 9;27(5):455-461. Epub 2016 Dec 9.

Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland.

 Supracondylar humerus fractures are usual in children but their recent trends are unclear.  A population-based study was performed to determine the epidemiology of childhood supracondylar humerus fractures during the decade, 2000 to 2009, in a geographic area of Oulu, Finland. Altogether, 565 extension-type supracondylar humerus fractures were included. The fractures and their treatment were analyzed according to the Gartland classification.  Fracture incidence increased by 28%, from 50.9 to 65.2 per 100,000 during 2000 to 2009 (β = 1.03,  < 0.001). The increase was from 41.3 to 57.6 per 100,000 in girls (β = 1.9,  < 0.001). Trampoline-related fractures in particular increased in girls. Type II fractures increased twofold from 7.1 to 16.3 per 100,000 (β = 1.1,  < 0.001), whereas type I fractures decreased from 22.4 to 20.9 per 100,000 (β = -0.3,  = 0.026).Surgical treatment increased during the 10 years study period from 32.6 to 51.8% ( = 0.022); it was in particular due to increase of operative care of type II fractures (from 5.9% in 2000-2001 to 37.1% in 2008-2009;  = 0.011). Lateral pin fixation increased from nil to six (10.7%) ( < 0.001).  The incidence and surgical stabilization of type II fractures in particular are increasing. There is a trend toward lateral pin fixation.
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http://dx.doi.org/10.1055/s-0036-1597270DOI Listing
October 2017

Supracondylar humerus fractures in children: the effect of weather conditions on their risk.

Eur J Orthop Surg Traumatol 2017 Feb 5;27(2):243-250. Epub 2016 Dec 5.

Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, POB 23, 90029, Oulu, Finland.

Introduction: Supracondylar humerus fractures are the most common fractures of the elbow in children. Many environmental factors such as weather conditions may affect the risk of these fractures. The purpose of the study was to analyze the effect of weather conditions (temperature, rainfall, wind) on fracture risk in children <16 years of age during the extended summer time period with the absence of snow cover.

Materials And Methods: All children <16 years of age with an outdoor supracondylar humerus fracture between May 1 and September 30 in a defined geographical area during the decade of 2000-2009 were included. Daily meteorological recordings for altogether 1526 study days were reviewed from the national weather service and the association of weather conditions and fractures were analyzed.

Results: A majority (79.7%, N = 181) of the fractures occurred on dry days versus rainy days (20.3%) (P = 0.011), and risk of a fracture was 3.5-fold higher on dry days as compared with rainy days (crude OR 3.5, 3.41-3.59, P < 0.001). The weather was warm, instead of cool or hot, when the majority of the fractures (N = 147, 64.8%) occurred (P = 0.008): Warm temperatures (15-24.9 °C) increased the fracture risk 2.6-fold (crude OR 2.64, 2.59-2.70, P < 0.001), compared with cool (<15 °C) days. The fracture incidence did not change according to the wind speed (P = 0.171). The findings were similar through the school term and summer vacation.

Conclusion: Dry and warm weather conditions increase the risk of outdoor supracondylar humerus fractures in children during the time period with the absence of snow cover.
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http://dx.doi.org/10.1007/s00590-016-1890-8DOI Listing
February 2017

Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: a double-blind, randomised controlled trial.

Lancet Infect Dis 2017 01 19;17(1):50-57. Epub 2016 Sep 19.

PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland; Oulu University Hospital, Department of Children and Adolescents, Oulu, Finland.

Background: Surgical site infections (SSIs) are a pervasive problem in surgery. Sutures coated or impregnated with triclosan might reduce the occurrence of SSIs, but evidence of their efficacy is limited, especially in children.

Methods: We designed a randomised, double-blind, controlled trial in patients who underwent elective or daytime emergency surgery at Oulu University Hospital (Oulu, Finland). We included children younger than 18 years staying in the paediatric surgery and orthopaedics ward for any elective or emergency surgery during the daytime and with anticipated use of absorbing sutures. Children were randomly allocated (1:1) to receive either triclosan-containing sutures or ordinary absorbing sutures. The primary outcome was the occurrence of superficial or deep surgical site infections according to the Centers for Disease Control and Prevention criteria within 30 days after surgery. The primary analysis was with modified intention to treat. This trial is registered at ClinicalTrials.gov, number NCT01220700.

Findings: Between September, 2010, and December, 2014, 1633 children were recruited. In the modified intention-to-treat group, SSIs occurred in 20 (3%) of 778 patients allocated to receive triclosan-containing sutures and in 42 (5%) of 779 patients allocated to receive control sutures (risk ratio 0·48, 95% CI 0·28-0·80). To prevent one SSI, triclosan-containing sutures had to be used in 36 children (95% CI 21-111). One patient died from suspected mitochondrial disease; no other expected or unexpected adverse events were reported in either of the groups.

Interpretation: Use of triclosan-containing sutures effectively reduced the occurrence of all SSIs compared with normal sutures. The results accord with the results of meta-analyses of previous studies in adults. Use of triclosan-containing sutures is a simple way to reduce SSIs in children.

Funding: The Alma and K A Snellman Foundation.
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http://dx.doi.org/10.1016/S1473-3099(16)30373-5DOI Listing
January 2017

Myoclonic movements of the elbow and wrist as a rare complication of supracondylar humerus fracture in a child.

J Pediatr Orthop B 2017 Sep;26(5):433-436

Departments of aChildren and Adolescents, Pediatric Surgery and Orthopedics bNeurosurgery cChildren and Adolescents, Pediatric Neurology, Oulu University Hospital dPEDEGO Research Center Oulu, MRC OULU, Oulu University, Oulu, Finland.

Supracondylar humerus fractures are associated with neurological complications. This report describes a child who suffered from persistent myoclonus-like movements of the elbow and wrist as a consequence of a previous displaced fracture. Symptoms were progressive. Seven years later, sensation was decreased in the ulnar nerve distribution. Palpation of the ulnar nerve exacerbated the myoclonic jerks. As symptoms progressed, electoneuromyography became abnormal. Cubital tunnel release and anterior transposition of the ulnar nerve were required to reach full recovery. Long-term outcome was excellent. In conclusion, myoclonus-like movements are a rare complication of supracondylar humerus fractures, resulting from ulnar nerve injury.
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http://dx.doi.org/10.1097/BPB.0000000000000381DOI Listing
September 2017

Micro-CT Analysis of Bone Healing in Rabbit Calvarial Critical-Sized Defects with Solid Bioactive Glass, Tricalcium Phosphate Granules or Autogenous Bone.

J Oral Maxillofac Res 2016 Apr-Jun;7(2):e4. Epub 2016 Jun 30.

Department of Oral and Maxillofacial Surgery, Research Group in Tissue Engineering, Faculty of Medicine, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu Finland.

Objectives: The purpose of the present study was to evaluate bone healing in rabbit critical-sized calvarial defects using two different synthetic scaffold materials, solid biodegradable bioactive glass and tricalcium phosphate granules alongside solid and particulated autogenous bone grafts.

Material And Methods: Bilateral full thickness critical-sized calvarial defects were created in 15 New Zealand white adult male rabbits. Ten defects were filled with solid scaffolds made of bioactive glass or with porous tricalcium phosphate granules. The healing of the biomaterial-filled defects was compared at the 6 week time point to the healing of autologous bone grafted defects filled with a solid cranial bone block in 5 defects and with particulated bone combined with fibrin glue in 10 defects. In 5 animals one defect was left unfilled as a negative control. Micro-computed tomography (micro-CT) was used to analyze healing of the defects.

Results: Micro-CT analysis revealed that defects filled with tricalcium phosphate granules showed new bone formation in the order of 3.89 (SD 1.17)% whereas defects treated with solid bioactive glass scaffolds showed 0.21 (SD 0.16)%, new bone formation. In the empty negative control defects there was an average new bone formation of 21.8 (SD 23.7)%.

Conclusions: According to findings in this study, tricalcium phosphate granules have osteogenic potential superior to bioactive glass, though both particulated bone with fibrin glue and solid bone block were superior defect filling materials.
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http://dx.doi.org/10.5037/jomr.2016.7204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970504PMC
August 2016

[Severe trampoline injuries and their risk factors among children and the young].

Duodecim 2016 ;132(11):1061-8

Background: Although the majority of trampoline injuries in children are minor, severe injuries occur as well.

Methods: We have analyzed the risk factors, treatment and outcome of severe trampoline injuries treated in the Oulu University Hospital in children and the young between April and November 2105.

Results: There was a total of eight severe injuries. Five injuries involved a danger of death. Almost all severe trampoline injuries resulted from an unsuccessful trick. A safety net was in use in half of the cases.

Conclusions: All cervical spine injuries would have been avoided provided that the children would have refrained from doing a somersault on the trampoline.
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August 2016