Fracture risk assessment in children with benign bone lesions of long bones

BACKGROUND Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated.AIM To investigate the risk factors for pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risk.METHODS We retrospectively reviewed 96 pediatric patients with benign bone lesions.We compared radiographic and clinical features between 40 patients who had fractures through a benign bone lesion and 56 who had no fracture.Information including histological diagnosis,anatomical site,radiographic appearance,severity of pain,and lesion size was recorded for the patients.A modified scoring system was proposed to predict the risk of fracture.RESULTS The univariate comparisons showed a significant difference between the fracture and non-fracture groups in terms of lesion type,pain,lesion-to-bone width,and axial cortical involvement of the patients(P<0.05).Lesion type,pain,lesion-tobone width,and axial cortical involvement were independently correlated with an increased risk of fracture.The mean score of the fracture group was 7.89,whereas the mean score of the non-fracture group was 6.01.The optimum cut-off value of the score to predict pathological fracture was 7.The scoring system had a sensitivity of 70%and a specificity of 80%for detecting patients with fractures.The Youden index was 0.5,which was the maximum value.The area under the receiver operator characteristic was 0.814.CONCLUSION Lesion type,pain,lesion-to-bone width,and axial cortical involvement are risk factors for pathological fracture.The modified scoring system can provide evidence for clinical decision-making in children with benign bone lesions.A bone lesion with a total score>7 indicates a high risk of a pathologic fracture and is an indication for prophylactic internal fixation.

Coronaviruses:An overview with special emphasis on COVID-19 outbreak with musculoskeletal manifestations

An acute respiratory illness caused by a novel coronavirus,namely,severe acute respiratory syndrome coronavirus 2,the virus that causes coro-navirus disease 2019(COVID-19),began spreading across China in late December 2019.The disease gained global attention as it spread worldwide.Since the COVID-19 pandemic began,many studies have focused on the impact of the disease on conditions such as diabetes,cardiovascular disease,pulmonary disorders,and renal malfunction.However,few studies have focused on musculoskeletal disorders related to COVID-19 infection.In this review,we update the current knowledge on the coronavirus with special reference to its effects during and after the pandemic on musculoskeletal aliments,which may inform clinical practice.

Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children’s hospital before second pandemic wave in Germany

Background Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019(COVID-19)pandemic.Healthcare workers in paediatries are a unique subgroup:they come into frequent contact with children,who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2(SARS CoV-2)and,therefore,may transmit the disease to unprotected staff.In Germany,no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.Methods We tested the staff at a large children's hospital in Germany for immunoglobulin(Ig)G antibodies against the nucle-ocapsid protein of SARS CoV-2 in a period between the first and second epidemic wave in Germany.We used a questionnaire to assess each individual's exposure risk and his/her own perception of having already been infected with SARS-CoV-2.Results We recruited 619 participants from all sectors,clinical and non-clinical,constituting 70%of the entire staff.The seroprevalence of SARS CoV-2 antibodies was 0.325%(95%confidence interval 0.039-I.168).Self-perceived risk of a previ-ous SARS-CoV-2 infection decreased with age(odds ratio,0.81;95%confidence interval,0.70-0.93).Having experienced symptoms more than doubled the odds of a high self-perceived risk(odds ratio,2.18;95%confidence interval,1.59--3.00).There was no significant difference in self perceived risk between men and women.Conclusions Seroprevalence was low among healtheare workers at a large children's hospital in Germany before the second epidemic wave,and it was far from a level that confers herd immunity.Self-perceived risk of infection is often overestimated.