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Pediatric foot fractures on radiographs: distribution and predictors of surgery
Journal article   Peer reviewed

Pediatric foot fractures on radiographs: distribution and predictors of surgery

Lewis Fanney, Vandan Patel, Shahwar M Tariq, Shijie Hong, Richard Davidson and Jie C Nguyen
Emergency radiology, v 31(3), pp 341-348
01 Jun 2024
DOI: https://doi.org/10.1007/s10140-024-02230-4
PMID: 38644451
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Adolescent Child Child, Preschool Female Foot Injuries - diagnostic imaging Foot Injuries - surgery Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Humans Infant Male Retrospective Studies Radiography
To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery. This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery. 1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3% and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%) of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95% CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95% CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95% CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95% CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors. Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.

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Collaboration types
Domestic collaboration
Web of Science research areas
Radiology, Nuclear Medicine & Medical Imaging
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