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Pediatric Hand Fractures: Epidemiology and Patterns of Management
Rebecca Hartley, MD; Josh Lam, MD; Ceilidh Anne Kinlin, MScPT; Karen Hulin-Poli, MScOT; Robertson Harrop, MD, MSc, FRCSC, FACS; Franki O.G. Fraulin, MD, FRCSC
University of Calgary, Calgary, AB, Canada

Introduction: Pediatric hand fractures are frequent and occur in predictable, age-dependent patterns. While common, only a low proportion of these fractures require surgical intervention. The purpose of this study was to characterize the types of hand fractures managed by Pediatric Plastic surgeons at one centre.

Materials & Methods: Data was collected retrospectively through chart review over one calendar year at a large tertiary pediatric centre. Patients were included in this study if they were under 18 years of age and had a hand fracture (defined as distal to the carpus). Patient demographics were recorded from medical health records and each fracture was detailed individually by using the hospital's picture archiving and communication system. Statistical analysis, using the chi-square test, was performed using patient demographics or fracture characteristics as the independent variable and surgical intervention (defined as any reduction or internal fixation) as the dependent variable with a p-value of <0.05.

Results: The 608 charts reviewed identified 559 fractures in 514 patients. Of these, 68.3% patients were male. The incidence of hand fracture was 91.2 per 100,000 per year. The most common bone fractured was the proximal phalanx (31.9%), the majority of fractures occurred in the little finger (45.3%), and there were 260 epiphyseal fractures (46.3%). The mechanism of injury (MOI) and type of fracture depended upon patient age:

Most patients sustained low energy closed injuries and only a small proportion of injuries involved multiple fractures (8.1%). The majority of fractures were managed non-operatively, with only 10.2% requiring surgery. Chi-square analysis revealed fractures with displacement greater than 2 millimeters, comminution, intra-articular component, angulation greater than 15 degrees in the anterior-posterior or lateral planes, rotation, and open component were significant.

Conclusions: Even though pediatric hand fractures are common, the overwhelming majority of pediatric hand fractures referred to hand specialists did not require surgery. Modifying risk factors to prevent pediatric hand fractures are difficult and we propose that efforts should instead be focused on identifying which of these fractures will require surgery.

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