Pediatric Hand Trauma: a Cohort Study Comparing Operative to Non-operative Cases
Brodie Parent, MD, MS1, Erin Anstadt, MD2, Chelsey A Johnson, MD1, James Fisher, MS2, Jennifer Fantuzzo, MS1, John R. Fowler, MD3 and Alexander Joseph Davit III, MD4, (1)University of Pittsburgh Medical Center, Pittsburgh, PA, (2)University of Pittsburgh, Pittsburgh, PA, (3)Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, (4)Department of Plastic Surgery, University of Pittsburgh Medical Center / Children's Hospital of Pittsburgh, Pittsburgh, PA
Hand trauma is a frequent reason for emergency medical care in children. The epidemiology, injury patterns and operations for this group are not well described in the literature. This study aims to describe the pediatric hand trauma population and their injuries, and identify risks associated with requiring an operation.
This was a retrospective cohort study of pediatric hand-trauma patients referred to the hand clinic at a tertiary care center from 2014-2019. Patients were grouped into operative and non-operative cohorts for comparison. All charts were abstracted. Summary statistics were computed, and Poisson regression was used to compute relative risks (RR) with 95% confidence intervals (CI) and p-values.
A total of 850 patients were referred for hand trauma in our metropolitan area, for an incidence of 2 cases per 1000 children over 5 years. The median age was 11.4 years (interquartile range 7.4-14.2). 299 patients (35%) were female, and 250 (29%) were minorities. The most common mechanisms of injury were sports-related (298, 35%), door slams (127, 15%), and falls (108, 13%). 126 patients (15%) required operative management, while 724 (85%) were non-operative. Fractures which were rotated, angulated, displaced, or intra-articular usually underwent an operation. Ring and small finger injuries were the most common and were more likely to require operations compared to other injuries (RR 1.24, CI 1.05-1.46, p=0.01). Phalangeal fractures were the most common overall, but metacarpal fractures were significantly more likely to require operations compared to other injuries (RR 1.6, CI 1.13-2.25, p-value=0.007). Compared to all other mechanisms, patients using motorized toys, scooters, or motor vehicles were four times more likely to require an operation (RR 4.21, CI 2.04-8.71, p<0.0001). Finally, male gender, Caucasian race, and older age were all associated with operative hand trauma (RR=1.15, CI 1.02-1.29, p=0.02; RR 1.14, CI 1.03-1.27, p=0.01; and RR 1.14, CI 1.01-1.30, p=0.04, respectively).
This represents one of the largest reported cohort studies in pediatric hand trauma, and our findings highlight several risk factors for complicated injuries requiring an operation. Older Caucasian males and children who play with motorized devices/scooters are at highest risk for operative hand trauma. In addition, injuries to the small and ring finger, and metacarpal injuries are more likely to require operations. These findings have important prevention implications, and may help emergency and primary care providers to triage injuries for early referral to hand surgeons.
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