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01) and stabilized gradually after 12 (approximately 1.141). 77.5% of fractures were treated surgically. There was an independent association of surgical intervention with age older than 6 years old (p less then 0.05). Absorbable plates were mainly applied to mandibular fractures in patients aged 0-7 and only 1 was removed because of insufficient fixation strength. Conclusions The primary cause of pediatric maxillofacial fractures in North China was falls; traffic accidents led more multiple fractures and associated injuries. Palate and mandible were the most common sites of pediatric maxillofacial soft tissue injuries and fractures, respectively. The proportion of mandibular fractures to mid-face fractures decreased with the increase of age until 12.Background In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. Methods In this prospective cohort study, all consecutive patients who were operatively treated for a DIACF in our Level 1 trauma center between August 2012 and January 2019 were included and followed for at least one year. All operative procedures were performed by two specialized foot and ankle trauma surgeons using the STA. Using multinomial logistic regression, risk factors for SSIs were identified. Results A total of 237 calcaneal fractures in 214 patients were included, of which 179 underwent open reduction and internal fixation and 58 a primary arthrodesis. Most patients were male (73.6%) and the mean age was 45.9 years. There were 16 patients that developed a SSI (6.8%), of which 9 (3.8%) were deep and 7 (3%) were superficial infections. The multivariate analysis pointed out that surgery within one week after injury increased the chance of a SSI, as well as an ASA of 2 or higher and more than 150 cc of blood loss during the procedure. Conclusion This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.Background Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW. Methods A longitudinal study was conducted between July 2015 and November 2017 and included children less then 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y. Results There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p= less then 0.001) and polytrauma (p= less then 0.001). MG-101 inhibitor No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased. Conclusion Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child.Civilian gunshot violence is common and concentrated in specific geographic regions of the world, consuming a significant proportion of trauma practice in those particular regions. Unfortunately, the state of clinical evidence is scarce, and it is fair to emphasize that the field is scientifically under-represented. In the current review, the authors point out key aspects and principles requiring attention when treating low energy gunshot wounds to the lower extremity. These treatment principles include the following management concepts 1) Conservative management of soft tissue injuries if the projectile causes no discomfort. 2) Conservative management of non-complete fractures of the tibia or femoral shaft. 3) Prophylactic fixation of non-complete peri-trochanteric fractures. 4) Fixation of allcomplete fractures. 5) Removal of all intra-articular projectiles. 6) Treating as septic arthritis if the missile passes through large bowel (not small bowel) prior to penetrating a joint capsule. The proposed concepts are based on available evidence from the literature and expert opinion. The authors also highlight challenges with conducting clinical studies in the field, given the high rate of 'loss to follow-up' and compliance issues in this particular group of patients.We analyze waste generation differences across Spanish regions by studying the evolution of two complementary indicators municipal solid waste per unit of GDP as well as in per capita terms. To that end, we apply the recent statistic developed by Phillips and Sul (2007) which allows us to test for the null hypothesis of convergence. In the present case, this hypothesis is equivalent to admitting that the waste generation follows a similar path across the Spanish regions. Our results lead us to reject this hypothesis, which implies that Spanish regional waste generation is quite heterogenous and exhibits several patterns of behavior. We observe that the northern regions exhibit the lowest waste ratios while the insular and Mediterranean coast regions have the highest waste generation. This different behavior is also explained by some socioeconomic factors. Per capita income, environmental spending and education level are helpful in this regard. The population dispersion and the number of years that a region has been governed by a left-wing party are also associated with lower levels of waste generation.
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