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Highlight • The largest and first study to compare EIN with CST for displaced tibial shaft fracture in a Chinese population. • The CST procedure had faster surgical time, cast duration, and longer hospitalization. Patients in EIN group began exercising and endured weight-bearing earlier. • The CST provided better results of coronal correction than EIN. Moreover, CST patients had less malalignment (> 5°) in complications. • The characteristics of the patient and fracture, the individual's situation and expectation should be considered when choosing the best approach., Background The objective of this study was to compare the outcomes and complications of patients who underwent either the calcaneal skeletal traction (CST) or the elastic intramedullary nails (EIN) procedure. Methods We retrospectively reviewed data of patients who underwent EIN or CST surgery for tibia shaft fracture at our center from 2013 to 2018. The patient demographics, fracture characteristics, radiographic information, length of hospital stay, and medical expenses were recorded. All patients were clinically followed-up until they started to walk or for at least 6 months. The treatment outcomes and postoperative complications of the two procedures were compared. Results Overall, 186 patients who underwent EIN and CST were included in the study. The EIN patients had more low-energy mechanism of injury. In radiographic evaluation, significant differences were observed in distributions of fracture classification and location. Moreover, associated fibula fractures were higher in the EIN group than in the CST group. The CST procedure had faster surgical time, cast duration and lower expenses, and longer hospitalization time. Although they required more clinical visits, patients in the EIN group began exercising and endured weight-bearing earlier than those in the CST group. The average time for bone healing was 68.5 days in the EIN group, and 69.6 days in the CST group. However, the CST provided slight better results of coronal correction than EIN. Moreover, CST patients had less malalignment (> 5°) in complications. None had delay union, nonunion, and shortening over 10 mm at final assessment. Conclusions Both EIN and CST patients showed similar treatment outcomes. Hence, not only the characteristics of the patient and fracture, but also the individual's situation and expectation should be considered when choosing the best approach.

Additional file 4: Supplementary Table 1. Cheng-Tang rating scores between the MM and NMM groups

Additional file 6: Supplementary material 2. case two

Additional file 2: Supplementary Figure 2. Physical examination of the child in Case two after MM

Additional file 3: Supplementary Figure 3. Physical examination of the child in Case two at final follow-up

Additional file 1: Supplementary Figure 1. Images of the child in Case two

Additional file 7: Supplementary material 4.STROBE checklist

Additional file 8. STROBE Statement—Checklist of items that should be included in reports of cohort s

Additional file 5: Supplementary material 1. case one

Purpose: To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures.Methods: This study retrospectively analyzed the epidemiological characteristics of fractures in children aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020.Results: A total of 10486 pediatric patients were included in the study, of whom 6,961 (66.38%) were boys, and 3,525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5,584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3,843 sites, 27.49%), distal ulna (1,740 sites, 12.44%), and distal radius (1,587 sites, 11.35%). The top three causes of injury were falls (7,106 cases, 82.10%), car accidents (650 cases, 65.72%), and pinch injuries (465 cases, 5.37%). Fractures predominantly occurred between July and November (4,664 cases, 48.87%) and on Saturdays and Sundays (3,172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4,339 cases, 45.46%).Conclusion: We should strengthen preschool children health and safety education and increase protective measures. It is necessary to allocate medical resources in a targeted manner, to establish a closed-loop regional pediatric trauma treatment system centered on trauma centers that links together regional trauma centers, and to establish substantively operating comprehensive pediatric trauma treatment teams that follow a multidisciplinary treatment model.

BackgroundUnintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants.MethodsA retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed.ResultsA total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases.ConclusionsSpecial attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.

Objective Botulinum toxin have been used to treat congenital muscular torticollis for the last 25 years; however, few studies have been published with only limited cases and short-term follow-up. The aim of the present study is to systematically review the effectiveness and safety of botulinum toxin injections for congenital muscular torticollis by analyzing these relevant literatures. Methods The authors searched PubMed, Web of Science, EMBASE, Cochrane Library, China Biology Medicine, for all articles about botulinum toxin injections for the congenital muscular torticollis. The MINORS evaluation tool was adopted to evaluate the quality of these studies. Meta-analysis calculations are made by R software 3.6.2. Results This study search involved strict inclusion criteria and targeted data collection. Ten studies were included, with a total of 411 patients, comprising 1 non-randomized experimental study and 9 cases or case series. The results of our meta-analysis of single rate showed that the overall effective rate of botulinum toxin for congenital muscular torticollis was 84% (95% confidence interval [CI] 67%-96%). After botulinum toxin treatment, the conversion rate to surgery was 9% (95% CI 4%-22%), and the adverse reaction rate was 1% (95% CI 0%-3%). The most common adverse reactions among these included studies involve injection site erythema and transient dysphagia. Conclusion Current evidence shows that botulinum toxin injections for the treatment of congenital muscular torticollis is safe and effective, with few serious adverse reactions. Further well-designed, larger randomized trials are warranted.