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Introduction. CT scan is regarded as the investigation choice for accurate depiction of blunt abdominal injuries in children and is considered as an inevitable tool in the armamentarium of the clinician before deciding for conservative management of these children. However over dependence on CT scan puts the patient to many disadvantages. The aim of this study to devise stratification criteria for the children with blunt abdominal injury and advise CT scan to the children only who really require it. Material and methods. All the children with blunt abdominal injury were studied prospectively over a period of two years. These children underwent clinical, biochemical and ultrasonographic assessment at presentation followed by CT abdomen. Efficacy of predefined clinical, biochemical and ultrasonographic parameters was compared with CT scan to triage the children with intra abdominal injury. Results. A total of 84 children were registered in the study based on final diagnosis of presence or absence of intra abdominal injury the children were divided in two groups. These groups were then compared for various clinical, laboratory and ultrasonographic parameters to predict intra abdominal injury. The children having isolated abdominal injury, tenderness, raised AST, ALT and amylase and free fluid on ultrasonography were found to have more chances of intrabdominal injury (p < 0.001). These parameters were the most sensitive parameters to predict intra abdominal injury and the cumulative sensitivity of these parameters was 99.7%. The CT abdomen was negative in 74.7% of the patients. Conclusion. Due to high negative rate of CT abdomen in children with abdominal trauma, its use as first line imaging investigation is questionable in all the children with abdominal trauma. We suggest that by utilizing clinical, biochemical and ultrasonographic parameters, the children at risk of intra abdominal injuries can identified with almost 100% accuracy mandating the use of CT scan only in these children.

Introduction. Isolated free fluid (IFF) on abdominal computed tomography in children with blunt abdominal trauma poses a diagnostic dilemma. The aim of this study is to present our experience of the entity and its role in management of these children. Methods. A prospective study was performed over a period of two and half years on all the children less than 14 years of age admitted to our hospital with blunt abdominal trauma and in whom the CT abdomen was done which demonstrated isolated free fluid with no sign of visceral injury. Demographic data, presenting clinical status, imaging data and management (nonoperative progress and operative findings) were collected and analyzed. Results. A total of 108 children were admitted with blunt abdominal trauma and who underwent abdominal CT during the period from July 2015 to December 2017. Isolated free fluid (IFF) was found in 26 children (24%). The mean age was 7.8 years with male predominance. Motor vehicle collisions were the most common mechanism of injury. At presentation abdominal tenderness was present in 8 of these children. Twenty two children had small IFF and 2 each had moderate and large fluid collections and the most common site being the hepatorenal pouch. One child each from moderate and large IFF group needed subsequent exploration. Conclusion. Children of blunt abdominal trauma with isolated free fluid on abdominal CT are managed conservatively. However, they need admission and repeated clinical assessment for early detection of delayed presentation of visceral injury entailing surgical intervention.

Both bone forearm fractures in adults are conventionally managed with plate xation for both radius and ulna. e fractures involving proximal half of radial sha need extensive muscle dissection, periosteal stripping and carry a risk of posterior interosseous nerve injury. Hybrid xation for such fractures with titanium elastic nail system ( TENs) for radial xation and standard plating for ulnar fracture is a potentially safer alternative for these fractures. e purpose of this study is to compare the outcomes of the aforementioned hybrid xation to conventional dual plating for adult both bone forearm fractures involving proximal half of the radial sha . Methods: Adult patients with both bone forearm fractures involving proximal half of the radial sha were randomly divided into a hybrid xation(A) and dual plating(B) groups over a two-year period. e patients were followed for a minimum of six months and radiological and functional outcomes were compared. Results: Radiological and functional outcomes between the two groups were comparable with the exception of wrist dorsi exion which was signi cantly reduced in the hybrid xation group. e surgical duration was signi cantly shorter in hybrid xation group. Loss of reduction and nail entry point pain were major complications in the hybrid xation group. Hypertrophic radial scar and transient posterior interosseous nerve palsy were major complications in the dual plating group. Conclusion: Hybrid xation using plate osteosynthesis for ulnar fracture and TENs for radial fracture is a valid option for treatment of adult both bone forearm fractures involving the proximal half of radial sha with a shorter surgical duration and less so tissue complications when compared to open reduction and plate osteosynthesis for both the fractures.

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