This study describes the outcome of supracondylar humerus fractures in children using crossed K-wires after closed or open reduction with the medial, lateral or bilateral approach. Patients treated between January 2000 and December 2019 were classified according to the Von Laer classification, complications were classified according to the Sink classification and clinical outcomes were classified according to modified Flynn criteria. In total, 364 patients with a mean age of 5.23 ± 2.45 years were included. The majority were type IV fractures (156; 42.9%) and 94 (60.3%) needed an open reduction for which the medial approach (53; 56.4%) was predominantly used. Overall, of 50 complications (31 using closed reduction, 19 open reduction), 17/50 (34%) needed revision surgery. An excellent clinical outcome was achieved in 348/364 (95.6%) patients. The approach used for open reduction as such had no influence on the complication rate or clinical outcome. For severely displaced fractures, the data showed that an open approach for crossed K-wires tended to result in fewer complications and better clinical outcomes than a closed reduction. If an open reduction is indicated, the required approach (medial, lateral or bilateral) should be primarily selected according to the requirements of the fracture pattern and eventual cosmetic considerations.

Spinal cord injury (SCI) leads to disabling condition. In Nepal the nationwide statistics of incidence and prevalence of SCI is still unclear which demands a systematic examination of crucial epidemiological aspects of SCI. An electronic search was conducted on PubMed, Ovid EMBASE, Cochrane Library and Google Scholar. Clinical studies investigating epidemiology of spinal cord injury were included. A narrative synthesis of the data that comprised 1796 patients was conducted. Males comprised 73%, and the mean age varied from 32 to 47 years. The two leading causes of SCI were falls (60%) and accidents (17%). Most patients had incomplete neurology (AIS grade B, C and D = 42%) followed by AIS A grade (36.3%). Cervical injury (37.4%) was the most common level of injury. Mortality during hospital stay was low (1.98%) whereas after rehabilitation was high (24.32%). The review contributes in understanding epidemiology of SCI in Nepal which is expected to help in planning for prevention and management.

Study design Cross-sectional study Objectives To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. Setting Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. Methods Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. Results Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. Conclusions PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.

Study Design: Cross-sectional study.Purpose: To compare bone density by computed tomography Hounsfield unit (CTHU) between the original pedicle trajectory (OPT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT).Overview of Literature: The significant pullout strength in CBT is believed to be due to increased screw–cortical bone contact; however, it allows for shorter/less-diameter screw placement, and the fixation is limited to the posterior one-third of the vertebral body, compromising the screw anchorage in the anterior vertebra.Methods: Computed tomography transverse sections of the L1–L5 (1,000 vertebrae) of 200 patients were cut into three planes: (1) horizontal to the pedicle, representing the plane for OPT; (2) in the caudocranial plane in the sagittal plane and divergent in the transverse plane representing the CBT; and (3) the caudocranial plane in the sagittal plane and parallel in the transverse plane representing the MCBT. For each trajectory, the CTHU of four points, namely, posterior cortex, mid-pedicle, midbody, and anterior cortex, were compared within the area of screw insertion.Results: The mean CTHUs of OPT, CBT, and MCBT were 354.2±70 HU, 529.9±75 HU, and 457.3±90 HU, respectively (p <0.01). The CTHU of the posterior cortex in MCBT was 65.6% higher than that in OPT and 14.9% lower than that in CBT. A comparable decline in CTHU with age was noted in CBT and MCBT (Pearson’s r : −0.20 vs. −0.22; adjusted R 2: 0.040 vs. 0.047). However, a higher decline in CTHU with age was observed in OPT (Pearson’s r =−0.38, adjusted R 2=0.14).Conclusions: MCBT has a significantly higher CTHU than OPT. The density in the posterior cortex in MCBT is comparable to that in the CBT trajectory. MCBT appears to be an alternative trajectory for lumbar spine fixation.

Background/Objectives: Injuries remain a major cause of childhood morbidity and mortality in Europe, despite improved prevention. Infants under one year are particularly vulnerable because of limited motor control and complete dependence on caregivers. Existing studies are often small or cover broad age ranges, limiting infant-specific insights. This study aims to provide a comprehensive overview of injury types, mechanisms, and treatments, focusing exclusively on infants aged zero to one year. Methods: This retrospective study analyzed 29,574 infants and children (<2 years) treated at a level 1 trauma department from 1993 to 2022. Primary data included main diagnosis, injury mechanism, and treatment. Injuries were classified by diagnosis and mechanism. Surgeries were categorized by procedure type. Results: Injury frequency increased with age. A total of 31.1% of cases occurred in infants (<12 months) and 68.9% in children (12–24 months). Head injuries were the most common trauma type (44%), particularly among infants (69.9%; children: 32.2%), while wounds (infants: 10.2%; children: 31.5%) and fractures (infants: 4.2%; children: 8.4%) were more frequent in children. Falls were the predominant mechanism (77.9%) across both groups. Most injuries were treated conservatively. A total of 228 surgical interventions were performed (0.8%), mainly for wounds (54.8%) and fractures (30.3%). Conclusions: This study shows that, even within the first two years of life, child development shapes both injury frequency and type. As mobility and independence increase, injuries rise, from predominantly head trauma among infants to a higher incidence of wounds and fractures in children. The majority of injuries were minor and managed conservatively.

Background: Open fractures in pediatric patients are uncommon but clinically relevant, often resulting from high-energy trauma or sports-related incidents. This study analyzes the demographic patterns, types of sports, injury mechanisms, treatment strategies, and outcomes in children and adolescents with sports-related open fractures. Methods: In this retrospective study, 74 pediatric patients with sports-related open fractures treated at a level 1 trauma center between 2002 and 2023 were documented. Parameters such as age, sex, fracture location, sport type, treatment modality, complications, and outcomes were evaluated. Results: The cohort included 74 patients, with a mean age of 13 ± 3.6 years. Open fractures of the upper extremity were most common (seen in 34 patients). Moreover, 10 open craniofacial and 27 open nasal fractures represented 50.0% of injuries, mainly in male athletes involved in contact sports. Soccer was the leading injury-related sport (n = 14; 18.9%). Surgical treatment was required in 28 patients (37.8%), most frequently using elastic stable intramedullary nailing, Kirschner wire fixation in the upper extremities or nasal bone reduction. Antibiotics were administered in 46 patients (62.2%), with a mean documented duration of 2.7 ± 3.1 days. An excellent outcome was documented in 95%. Conclusions: Sports-related open fractures in children primarily affect male adolescents in contact sports and involve the upper extremities and facial region. Conservative management is effective in stable, non-displaced and low-grade injuries. Surgical treatment is frequently indicated in open forearm fractures. The implementation of a structured trauma care protocol, incorporating early debridement, definitive treatment, and antibiotics, has been demonstrated to yield a safe and effective treatment outcome with a favorable prognosis for sports-related open fractures in children.