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Risk Factors for Upper Extremity Refractures in Children.
Hilton P Gottschalk1,2, Holly Hughes Garza3, Amanda N Barczyk4,3
1Central Texas Pediatric Orthopedics, Dell Children's Medical Center of Central Texas.
Journal of Pediatric Orthopedics
|July 14, 2022
Summary
Pediatric upper extremity refractures occur in 2% of patients, typically within 6 months. Midshaft forearm fractures and noncompliance significantly increase refracture risk.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Trauma research
Background:
- Refracture patterns in pediatric upper extremity fractures are not well-quantified.
- Large cohort studies assessing refracture odds and predictive factors are limited.
- Existing research lacks comprehensive analysis of associated patient-level and fracture-related factors.
Purpose of the Study:
- To determine the frequency and timing of upper extremity refractures in children.
- To identify patient-level and fracture-related factors associated with refracture risk.
- To quantitatively assess the odds of refracture based on various characteristics.
Main Methods:
- Retrospective review of medical records for pediatric patients (1-18 years) with upper extremity fractures.
- Analysis of fracture characteristics, patient demographics, and treatment compliance.
- Bivariate and multivariable logistic regression to identify predictors of refracture.
Main Results:
- 2% of patients experienced refracture within 2 years, with a median time of 6 months.
- Midshaft location, angulated or buckle fractures, and forearm fractures were associated with higher refracture rates.
- Noncompliance with treatment recommendations increased refracture odds by 4 times.
Conclusions:
- Refracture is uncommon but significant in pediatric upper extremity injuries.
- Forearm midshaft fractures and noncompliance are key risk factors.
- Falls and high-energy mechanisms are common causes of refracture.
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