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Spinal Injuries among Paediatric Patients

Teaser: 

Dr. Khaled Almansoori, MD, M.Ed, FRCSC,

Adult & Paediatric Spine Surgeon, Department of Orthopaedic Surgery, Advocate Christ Medical Center, Illinois, USA.

CLINICAL TOOLS

Abstract:Due to the distinctive anatomic and biomechanical features of the growing paediatric spine, children are susceptible to unique patterns of spinal injuries. Although clinical examination can help guide management, physicians are often required to rely on advanced imaging. Imaging interpretation can be challenging when considering that abnormal parameters among adults, are often within normal physiological limits in children. In general, spinal injuries in children younger than nine years of age are often managed non-operatively, while adolescents are typically managed by adult treatment principles. With the exception of neurologic injuries, most paediatric spinal injuries demonstrate good to excellent prognosis and outcomes.
Key Words: fracture, injury, spine, paediatric, children.

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Due to the unique properties of the growing spine, including greater elasticity, osseous plasticity, presence of growth centers, relatively strong ligaments, and greater joint mobility, paediatric patients are susceptible to unique fracture patterns and injuries.
There are absolute contraindications regarding return to play decisions.
Children under 13 years of age with vertebral body compression fractures can progressively restore their vertebral height until skeletal maturity.
The vast majority of spine injuries among children under nine years of age, even when relatively unstable, can be managed non-operatively.
Pre-adolescent patients with complete spinal cord injuries are at high risk for developing progressive scoliosis and have not been shown to demonstrate any better neurological outcomes when compared to adults.
The cervical spine is the commonest area of spine injuries with the C1-3 vertebral levels being more commonly seen in children under eight years of age.
A standard immobilization board should not be used for children under eight years of age without an occipital recess or 2-3cm of padding to elevate their body relatively to their head.
Adult radiographic spinal parameters are often unreliable in children and severe neurologic injuries can be sustained in spite of normal imaging results.
Clinical examination is fairly unreliable for identifying spinal column injuries among pre-school patients and it is often necessary to rely on advanced imaging.
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The Impact of Aging on the Liver

The Impact of Aging on the Liver

Teaser: 

David Stell, PhD, FRCS(Gen) and William J. Wall, MD, FRCS(C), Department of Surgery and Multi-Organ Transplant Program, London Health Sciences Centre, London, ON.

The process of aging does not produce changes in the liver that can be described as pathological. The major age-related alterations are a reduction in liver mass and a reduction in total blood flow, neither of which interferes with the liver's normal homeostatic functions. In spite of the liver's resilience, however, the aged liver is more vulnerable to injury from toxins, viruses and ischemia, and its capacity to regenerate is slowed. There also is a decline in liver enzymes with aging that affects metabolic clearance of drugs, a finding that has implications for drug dosing in the elderly.
Key words: liver, aging, function, metabolism, injury.

Falls are Leading Cause of Injury Admissions to Ontario Hospitals

Falls are Leading Cause of Injury Admissions to Ontario Hospitals

Teaser: 

Falls are the leading cause of injury admissions to Ontario acute care hospitals, especially for people over 65, according to figures released by the Canadian Institute for Health Information (CIHI).

Of the 68,222 injury admissions to Ontario's acute care hospitals in 1996/97, 58% were caused by falls, followed by motor vehicle collisions (14%) and intentional injuries (6%).

In 1996/97, Ontario residents spent 628,211 days in acute care hospitals due to injuries. Of these patient days, 72% were due to falls. The average length of stay in hospital was 11 days for falls compared to 9 days for all injury hospital admissions.

"Falls account for 86% of hospital admissions for people 65 years of age and older [with an injury] and the statistics are quite striking for older women. In fact, twice as many older women are admitted to hospital because of falls than men of the same age," explains CIHI spokesperson Daria Parsons.

Slipping, tripping, stumbling and falling from one level to another are the most common causes of injury admissions due to falls, in all ages and particularly for people aged 65 and older. The majority of falls occur in January, February and March. The most frequent type of injury is orthopaedic, largely bone fractures and dislocations, which are seen more often in the elderly.

CIHI's analysis shows that from 1992/93 to 1996/97, the number of injury admissions due to falls has remained relatively stable, with women representing more than half of the hospital admissions.

Causes of Injury Admissions for People Aged 65 and Older, 1996/97

In 1996/97, there were 27,650 injury admissions in people aged 65 and older, accounting for:

  • 41% of all injury admissions
  • 67% of hospital days due to injury
  • 86% of admissions in people aged 65 and older were due to falls, totalling 23,689; 5% (1,439) were due to motor vehicle collisions; and other causes accounted for 9% (2,522)
  • majority of injury admissions due to falls, for those 65 years of age and over, occur in women
These figures come from the Ontario Trauma Registry's (OTR) 1998 report on hospital injury admissions for the one-year period, April 1, 1996 to March 31, 1997. Managed by CIHI, the registry is funded by the Ontario Ministry of Health and provides current provincial and regional data on hospitalization resulting from injury in Ontario.

Information from the OTR is used by researchers and injury prevention specialists to develop and monitor injury prevention programs. The Ontario Ministry of Health has identified falls in the older population as a priority theme for injury prevention.

The Canadian Institute for Health Information

Created in 1994, CIHI is a national, not-for-profit organization with a mandate to develop and maintain Canada's integrated health information system. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health.

The CIHI can be found on the world wide web at www.cihi.ca.