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Year : 2018  |  Volume : 52  |  Issue : 5  |  Page : 447-448
Let's give our best to the children: The pediatric trauma symposium

Guest Editor, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India

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Date of Web Publication4-Sep-2018

How to cite this article:
Agarwal A. Let's give our best to the children: The pediatric trauma symposium. Indian J Orthop 2018;52:447-8

How to cite this URL:
Agarwal A. Let's give our best to the children: The pediatric trauma symposium. Indian J Orthop [serial online] 2018 [cited 2019 Dec 7];52:447-8. Available from:
The last decade has seen an explosion of knowledge in all streams of orthopedic surgery, with pediatric musculoskeletal trauma being no exception. The introduction of super-specializations has further added both precision and technicalities to its content. The aim of the present symposium is to provide a balanced mix of reviews, meta-analysis, original articles, and case illustrations to the readers interested in pediatric trauma. Conditions which could pose a challenge both in terms of diagnosis and management are dealt in a way to give readers a “to do” approach.

Starting with often-quoted cautionary statement, “children are not miniature adults,” the pediatric skeleton has a host of peculiarities making it distinct from adults: presence of epiphyseal growth plates at bone ends, bone elasticity and thick periosteum, relative laxity of ligaments and joints, disproportionate body dimensions, for example, large skull, immature gait patterns, prone to falls, rapid bone healing potential, and remodeling potential.

The foremost question which arises before we begin is the magnitude of the problem. Although trauma registries are well established in high-income countries, statistics from our country remain largely undocumented. Children <15 years of age comprise about one-third of the total Indian population and up to one-fourth of hospital admissions.[1],[2] Prospective epidemiological data from a tertiary care center of North India hinted a male predominance (58.5%) and age group 6–15 years being more susceptible to trauma.[3] Fall-related injuries (59%) were more common than road traffic-related accidents, a finding different from the Western literature.

It is imperative to constantly educate and re-equip ourselves with both basic and recent advances. The present Indian Journal of Orthopaedics issue includes an update on pediatric cervical spine trauma, tibial shaft fractures, femoral neck fractures, and perhaps, the more important open injuries in this age group.[4],[5],[6],[7] Conservative management still remains the cornerstone strategy to manage most of the pediatric fractures. The budding orthopedic surgeons although enveloped with newer operative techniques and a plethora of new implants must become skilled at the application of a well-molded and effective cast. It is equally important to understand the factors responsible for cast failures and rectify them. The manuscript analyzing the redisplacement of forearm fractures treated in cast closely examines these aspects and aligns us to best execution of conservative management.[8]

Urbanization is an upcoming trend and has its toll on children for both better and worse reasons. Today's youngster and adolescents are more inclined to sports and other competitive games, thanks to infrastructural support and community awareness. Anterior cruciate ligament injuries form a major chunk of sports medicine. An aggressive rehabilitation remains the key to early return to recreational activities following operative reconstructions.[9] Another closely linked trend is the multiply injured children in the emergency department (ED). In high-income world regions, the prevalence described is as high as 600 cases/10,000 children.[10] A report from the United Kingdom registry listed 2 million children attending ED with injuries each year and over 300 with a major trauma (Injury Severity Score >15).[11] The exact figures from our country still remain unknown. It is essential to acquire relevant knowledge besides being systematic and structured in approach to multiply injured children.[12] A team approach has shown better outcome in such scenarios. Several implants for managing pediatric fractures are now available.[13] One must not forget that simpler implants might work as efficiently as bulky ones for pediatric fractures, if used appropriately. Hip spica is fairly well tolerated in children and one should not be hesitant in its use, if indicated.

Injuries in children portray regional distinctiveness and are influenced by social, cultural, and religious practices. Contrary to the high-income populations where firearms are one of the foremost reasons for foreign body-inflicted musculoskeletal injuries in children, Indian children display an array of entirely different foreign bodies – dhaga/rubber band, needles, wooden twigs, glass bangles, etc.[14],[15] An awareness of the societal characteristics is thus important for the clinician, both for injury diagnosis and treatment plan.

An often-forgotten aspect in childhood trauma is the long term impact of fracture management and its influence on child's activities. It is already well known that growth-plate deformities can manifest several years later (e.g., Salter Harris Type V injuries and articular fractures). Studies with long term followup are indispensible to guide the clinician to prognosticate the patients and plan management accordingly.[16]

Evidence-based practices still have to go a long way in pediatric orthopedics and trauma surgery is no exception. The symposium envisages discussing some of the debated issues in addition to the commonly faced fracture situations. The exposed or buried Kirschner wires in lateral condyle humeral fractures,[17] parallel or divergent configuration for wire fixation in supracondylar humeral fractures,[18] or single-bone or both-bone fixation for pediatric unstable forearm fractures [19] are some of the contested issues which are discussed. Several other growth-plate injury patterns have been illustrated using carefully selected case examples.[20] As is evident from these research articles, dedicated research with well-thought-out and structured protocols will answer many of our queries in the future. The future lies in conscientious and judicious use of the best available evidence in conjunction with clinical expertise and giving the best to our younger generation.

   References Top

Census of India; 2011. Available from: [Last accessed on 2018 Mar 09].   Back to cited text no. 1
Pal R, Agarwal A, Galwankar S, Swaroop M, Stawicki SP, Rajaram L, et al. The 2014 Academic College of Emergency Experts in India′s INDO-US Joint Working Group (JWG) white paper on "Developing trauma sciences and injury care in India". Int J Crit Illn Inj Sci 2014;4:114-30.   Back to cited text no. 2
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Singh O, Gupta S, Azhar M, Darokhan UD, Ahmad S, Charak SS, Sen A. Epidemiology of pediatric musculoskeletal injuries and their pattern in a tertiary care center of North India. Indian J Orthop 2018;52:449-53.   Back to cited text no. 3
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Gopinathan NR, Viswanathan VK, Crawford AH. Cervical spine evaluation in pediatric trauma: A review and an update of current concepts. Indian J Orthop 2018;52:489-500.   Back to cited text no. 4
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Patel NK, Horstman J, Kuester V, Sambandam S, Mounasamy V. Pediatric tibial shaft fractures. Indian J Orthop 2018;52:522-8.   Back to cited text no. 5
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Sharma A, Gupta V, Shashikant K. Optimizing management of open fractures in children. Indian J Orthop 2018;52:470-80.   Back to cited text no. 6
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Palocaren T. Femoral neck fractures in children: A review. Indian J Orthop 2018;52:501-6.   Back to cited text no. 7
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Arora R, Mishra P, Aggarwal AN, Anshuman R, Sreenivasan R. Factors responsible for redisplacement of paediatric forearm fractures treated by closed reduction and cast: Role of casting indices and three point index. Indian J Orthop 2018;52:536-47.   Back to cited text no. 8
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Aylyarov A, Tretiakov M, Walker SE, Scott CB, Hesham K, Maheshwari AV. Intrasubstance anterior cruciate ligament injuries in the pediatric population. Indian J Orthop 2018;52:513-21.   Back to cited text no. 9
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Odetola FO, Gebremariam A. Paediatric trauma in the USA: Patterns of emergency department visits and associated hospital resource use. Int J Inj Contr Saf Promot 2015;22:260-6.   Back to cited text no. 10
Cleugh FM, Maconochie IK. Management of the multiply injured child. Paediatr Child Health 2013;23:194-9.   Back to cited text no. 11
Lahoti O, Arya A. Management of orthopaedic injuries in multiply injured child. Indian J Orthop 2018;52:454-61.   Back to cited text no. 12
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Dey S, Mishra K, Nagda TV, Dhamele J, Rathod C, Dey D. Titanium elastic nailing with temporary external fixator versus bridge plating in comminuted pediatric femoral shaft fractures: A comparative study. Indian J Orthop 2018;52:507-12.   Back to cited text no. 13
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Choi PM, Hong C, Bansal S, Lumba-Brown A, Fitzpatrick CM, Keller MS, et al. Firearm injuries in the pediatric population: A tale of one city. J Trauma Acute Care Surg 2016;80:64-9.   Back to cited text no. 14
Agarwal A. Foreign body related extremity trauma in children: A Single-Center experience. Indian J Orthop 2018; 52:481-88.   Back to cited text no. 15
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Ryu SM, Yoon DH, Park SG. Clinical and radiographic outcomes of pediatric radial head fractures. Indian J Orthop 2018;52:561-67.   Back to cited text no. 16
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Prasad A, Mishra P, Aggarwal AN, Chadha M, Pandey R, Anshuman R. Exposed versus buried Kirschner wires used in displaced pediatric fractures of lateral condyle of humerus. Indian J Orthop 2018:52:548-53.   Back to cited text no. 17
Gopinathan NR, Khan S, Sudesh P, Behera P. Outcome analysis of lateral pinning for displaced supracondylar fractures in children using three Kirschner Wires in parallel and divergent configuration. Indian J Orthop 2018;52:554-60.   Back to cited text no. 18
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Yong B, Yuan Z, Li J, Li Y, Southern EP, Canavese F, et al. Single bone fixation versus both bone fixation for pediatric unstable forearm fractures: A systematic review and metaanalysis. Indian J Orthop 2018;52:529-35.   Back to cited text no. 19
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Sabharwal S, Sabharwal S. Growth plate injuries of the lower extremity: Case examples and lessons learned. Indian J Orthop 2018;52:462-69.  Back to cited text no. 20
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Correspondence Address:
Dr. Anil Agarwal
4/103, East End Apartments, Mayur Vihar Ph-1 Ext., New Delhi - 110 096
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ortho.IJOrtho_376_18

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