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Phalangeal Fractures in Pediatric Hand Trauma: An Analysis of Epidemiology and Risk Factors
Meeti Mehta, BS1, Anne E Glenney, BA2 and Alexander J Davit III, MD3, (1)University of Pittsburgh School of Medicine, Pittsburgh, PA, (2)University of Pittsburgh Medical Center, Pittsburgh, PA, (3)Department of Plastic Surgery, University of Pittsburgh Medical Center / Children's Hospital of Pittsburgh, Pittsburgh, PA


Background
Phalangeal fractures are the most common pediatric hand trauma, but the epidemiology and injury patterns for this group are not well described. This study examines injury characteristics of the pediatric hand trauma population to identify risks associated with phalangeal fractures.

Methods
A retrospective cohort study of pediatric hand trauma patients from 2010-2020 was performed. Patients sustaining phalangeal fractures were included. Charts were abstracted for demographic and clinical details. Geographical/socioeconomic data were obtained from the US Census Bureau. Summary statistics were calculated, chi-square analysis was performed, and binomial regression was used to compute relative risks (RR). Alpha = 0.05 used for significance.
Results
1,311 patients sustained hand trauma, with 754 (57.5%) phalangeal injuries. The most common mechanisms of injury were sports (n=307, 41%), door slams (n=145, 19%), falls (n=84, 11%), and household mishaps (n=78, 10%). Compared to all injury mechanisms, violence, motor vehicle accidents, and self-inflicted injuries were associated with a reduced risk of phalangeal fractures (RR 0.22, CI 0.13-0.37, p<0.001; RR 0.16, CI 0.04-0.60, p=0.002; and RR 0.03, CI 0.01-0.12, p<0.001, respectively). Among fracture types, buckle fractures, and Salter-Harris fractures were more likely to involve the phalanges (RR 5.58, CI 1.73-18.01, p=0.001; RR 4.73, CI 1.90-11.76, p<0.001, respectively). Phalangeal fractures were frequently open (n=159, 21%) and were associated with over three times greater risk of open fracture (RR 3.58, CI 2.19-5.86, p<0.001). Fingertip injuries were the most common concomitant injury in our cohort (n=158, 21%), associated with nearly two times greater risk of phalangeal fractures (RR 1.64, CI 1.21-2.21, p<0.001). Age > 14 years was associated with reduced risk of phalangeal fractures (RR 0.42, CI 0.34-0.52, p<0.001), while female gender was associated with an increased risk of phalangeal fractures (RR 1.37, CI 1.13-1.65, p<0.001). Over a quarter (28.5%) of phalangeal fracture patients had incomes $43,000-$53,999 compared to 23.2% of non-phalangeal patients (p=0.042). In contrast, 33.6% of non-phalangeal fracture patients had incomes $54,000-$70,999 compared to 27.5% of phalangeal patients (p=0.015). Most phalangeal patients (92.7%) resided in urban areas compared to 90.5% of non-phalangeal patients (p=0.016).

Conclusion
Our findings illustrate risk factors for phalangeal fractures in the largest reported cohort in pediatric hand trauma to date. Younger female patients from urban, lower-income households are at highest risk for phalangeal fractures. Additionally, buckle, open, and Salter-Harris fractures are more likely to involve the phalanges. These findings can aid in the emergent triage of phalangeal fractures, allowing for earlier intervention by hand specialists.

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