Factors associated with increased severity of pediatric forearm fractures

Background/Purpose: Orthopedic intervention rates for pediatric forearm fractures (defined as displaced fractures requiring orthopedic manipulation to realign) are rising which suggests an increase in fracture severity. Our objective is to evaluate the hypothesis that pediatric fractures treated with orthopedic intervention are associated with major trauma mechanisms and increased weight status in comparison to non-intervention controls.

Methods: Retrospective analysis of patients 0-17 years evaluated for isolated forearm fractures at a large urban pediatric emergency department from 2003-2006. Descriptive statistics and bivariate analyses were used to compare fractures treated with orthopedic intervention to those not requiring intervention.

Results/Outcomes: Of 929 forearm fractures, there were 333 intervention cases (35.9%) and 596 (64.1%) non-intervention controls. The overall cohort was 64% male, 80.1% African-American, and had a mean age of 8.4 (± 3.9) years. Intervention cases were more likely to be male [OR 1.6 (95% CI 1.2-2.1)]; these groups did not differ in mean age or race/ethnicity. Intervention cases had a greater odds of major trauma mechanisms [OR 1.9 (95% CI 1.1-3.4)] including pedestrian injuries and motor vehicle collisions. The proportion of intervention cases (75/329, 22.8%) and non-intervention controls (140/563, 24.9%) having a weight for age/gender >95th percentile were not statistically different [OR 0.9 (95% CI 0.6-1.2)].

Conclusions: A large proportion of forearm fractures in our study population require orthopedic intervention. Need for intervention is significantly associated with male gender and major trauma mechanisms but is not associated with increased weight status. Preventive strategies to reduce displaced forearm fractures should target these major trauma mechanisms.