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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Trends in Pediatric Distal Radius Fractures Presenting to a Level 1 Metropolitan Emergency Department
Eric Wenzinger, BS; Simon Ivey, MD; Fernando Herrera, MD
MUSC University Hospital, Charleston, SC

Objective: Distal radius fractures are the one of the most common fractures in pediatric patients. The purpose of this study was to characterize the trends found in pediatric patients presenting to a Level 1 Emergency Department with distal radius injuries.

Methods: Patients presenting to the emergency department with ICD 9 codes corresponding to distal radius fractures were identified. All patients above the age of 12 were excluded from this study to increase the likelihood that all study participants were skeletally immature. Demographic information was collected including age, sex, race, insurance status, mechanism of injury, treatment provided, type of fracture, co-morbid medical diagnoses, and medications. Age was further stratified by three age groups (0-4 years, 5-8 years, and 9-12 years) and frequency of each group was recorded. Statistical significance of categorical variables between groups was determined using chi squared analysis.

Results: The majority of patients in the study were male (57.6%). The average age of the participants in this study was 8 years. The most frequent age group was 9-12 years of age (49.6%) followed by 5-8 years (34.4%) and 0-4 years (16.0%). The majority of the patients in this study were Caucasian (66.4%) while remaining population was classified as African American (25.6%), Hispanic (6.40%), and other (2.0%). Eight percent of patients had a psychiatric/developmental disorder (ADD, ADHD, ODD, MDD). Majority of the patients had private insurance (54.4%) while the remaining patients had Medicaid (31.2%), Uninsured (7.2%), or not recorded (7.2%). The most common mechanism of injury was fall (89.6%) followed by MVA (4.8%) and blunt force trauma (4.8%). Sixty-two of the 125 fractures (49.6%) were displaced while the remaining fractures were nondisplaced (12.0%) or buckle fractures (38.4%). In the displaced group, 24.2% were Salter-Harris Type 2. Displaced fractures were found to be more frequent in African American patients (59.4%) than Caucasian patients (44.6%). The majority of patients (57.6%) were treated with splinting alone while the remaining 42.3% were treated with closed reduction and casting (CRC). Within the CRC group, 11% required subsequent percutaneous pinning do to failure.

Conclusions: Pediatric distal radius fractures are most commonly found in Caucasian males between the ages of 9 and 12 with private insurance. Most of these fractures are displaced and do not involve the growth plate which require only conservative management (CRC or splinting) and occur secondary to a fall on the playground or at a sports related activity.

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