Is attention deficit and hyperactivity disorder a risk factor for sustaining fractures of proximal humerus?

To evaluate whether or not children with displaced proximal humerus fractures are more likely to have attention deficit and hyperactivity disorder (ADHD).

Between January 2010 and February 2013, we retrospectively evaluated 42 children with proximal humerus fractures. Requirements for inclusion were an open epiphyseal plate and a non-pathological fracture of the proximal humerus. Fractures were classified according to Salter-Harris, Neer and Horwitz. Following orthopaedic examination, all of the children were consulted to child psychiatry department of our hospital. Orthopaedic examination included a detailed physical examination; the assessment of the overall shoulder functions using the Constant score. Diagnostic and Statistical Manual of Mental Disorders, Text Revisions (DSM-IV-TR) were used for psychiatric examination.

9 of the 42 children with proximal humerus fractures consulted to child psychiatry were put ADHD diagnoses (21 %). Of the remaining 33 children without ADHD diagnosis, 5 children were operated; percentage of surgery was 15%. We found statistically significant difference between the rates of ADHD diagnosed children with proximal humerus fractures and ADHD diagnoses in normal population (p<0.01). There was also statistically significant difference between operation rates of children with or without ADHD diagnosis (55 % vs. 15 %) (p<0,01).

ADHD can be accepted as a risk factor for sustaining high energy trauma and rate of ADHD children who were operated was significantly more than normal children. This might be due to more displaced, open fractures or polytrauma - higher energy trauma- they sustained. Deciding on the treatment method, surgery may be treatment of choice in certain children with severely displaced, irreducable, fractures or polytrauma with accompanying ADHD due to the potential difficulties during follow up period.