Background: In the current diagnostic procedure, generally, both plain radiographs and 3D-CT scans are used for the diagnosis of acetabular fractures. There is no consensus regarding the value of a three-dimensional computerized tomographic (3D-CT) scan alone in the classification of acetabular fractures. In this study, we compared the accuracy of 3D-CT scan and plain radiography through the evaluation of their agreement with the intraoperative surgeon's classification. Method: In a retrospective study, patients who were referred to our center with an acetabular fracture and underwent surgical treatment were included. The classification of acetabular fractures was performed once using Judet view plain radiographs and once using a 3D-CT scan by the corresponding one Experienced musculoskeletal radiologist one independent trauma fellowship-trained orthopaedic who routinely treat acetabular fractures and based on Letournel and Judet classification (17 and 23 years of experience respectively). Cohen's kappa value was used for the assessment agreement between the two imaging modalities, as well as between the imaging modalities and intraoperative classification. Results: Medical files of 152 patients with acetabular fracture were retrospectively reviewed. A kappa value of 0.236 was obtained as the agreement level between radiographs and intraoperative findings (p < 0.001). A kappa value of 0.943 was obtained as the agreement level between 3D-CT and intraoperative classification (p < 0.001). An agreement level of 0.264 was found between the Judet radiographs and 3D-CT scans (p < 0.001). Conclusions: 3D-CT scans are reliable enough in the classification of acetabular fractures, and plain radiographs could be omitted to avoid radiation exposure as well as to reduce the cost for patients who sustain acetabular fractures.
Introduction: Gastroenteritis (GE) is one of the most common pediatric diseases.
Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized
children. Yet, there is no consensus on the ideal method of treatment.
Objectives: we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in
children with GE.
Patients and Methods: This is a double blind randomized clinical trial, which was conducted
on infants of 6 months up to 14 years children with GE. Children were randomly assigned
in 2 different groups. Group A; received 20 cc/kg 0.9% isotonic saline as a bolus, and 0.45%
hypotonic saline as sum of maintenance fluid and volume deficit. Group B was treated with
the same bolus and 0.9% isotonic saline with 20 mEq/L KCl as sum of maintenance fluid
and volume deficit. Blood and urine samples were taken at admission, 4 and 24 hours. Data
were analyzed by independent t test, Mann-Whitney U test, Friedmann test, chi-square and
2-tailed repeated measurements by SPSS version 19.
Results: Baseline hyponatremia and isonatremia were detected in 24 (31.5%) and 51 (67.1%)
patients, respectively. Mean level of sodium at T0, T4 and T 24 mentioned no significant
difference between groups. No hypernatremia was noted by administering isotonic saline.
Results showed that 4 and 24 hours after administration isotonic saline, the mean plasma
sodium differed significantly in baseline hyponatremic patients. However, no significant
difference was noted after 4 and 24 hours in group A.
Conclusion: According to the considerable effect of isotonic saline on hyponatremic patients,
it seems that administering isotonic fluids regardless of the types of dysnatremia can be
recommended to lessen clinicians’ conflicting decision-making in selecting an appropriate
fluid.
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