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Increased open fracture complications following pediatric all-terrain vehicle accidents
Timothy W Torrez1, Jimmy Hicks2, Vincent Bonner2
1University of California Los Angeles, David Geffen School of Medicine, CA, USA; University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA.
Insights
All-terrain vehicle (ATV) open fractures in children are more complex, leading to higher rates of revision and malunion compared to other pediatric open fractures. This highlights the significant risks associated with ATV use in young individuals.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Injury Epidemiology
Background:
- All-terrain vehicle (ATV) related open fractures are often high-energy injuries.
- These fractures can be highly contaminated, posing significant treatment challenges.
- Pediatric open fractures from ATVs may present unique complications compared to other causes.
Purpose of the Study:
- To compare the complexity and outcomes of pediatric open fractures caused by ATVs versus non-ATV related accidents.
- To identify specific differences in fracture patterns, severity, and complications.
- To inform clinical expectations and patient family guidance regarding ATV-related injuries.
Main Methods:
- Retrospective chart review of 97 pediatric open fractures (2015-2021).
- Comparison between 35 ATV-related and 62 non-ATV related open fractures.
- Data collected included demographics, fracture patterns (AO/OTA), Gustilo-Anderson classification, procedures, operative findings, and complications.
Main Results:
- ATV fractures showed a significant difference in AO/OTA distribution, with more humerus fractures.
- A higher proportion of ATV fractures were severe (Type II and III) Gustilo-Anderson classifications (77.1% vs. 56%).
- Revision/reoperation rates (23% vs. 15%) and malunion rates (4.3% vs. 0%) were higher in the ATV group.
Conclusions:
- Pediatric open fractures from ATV injuries are generally more complex.
- Higher rates of revision surgery and malunion are associated with ATV-related fractures.
- Findings underscore the dangers of ATVs for children and aid in managing patient and family expectations.
Background:
ATV (All-Terrain Vehicle) related open fractures are often high energy and may be highly contaminated. We asked whether they were more complicated than other open fractures in pediatric patients.
Methods:
A retrospective chart review was performed comparing ATV associated open fractures to open fractures sustained in non-ATV related accidents. 97 pediatric open fractures from 2015 to 2021 were identified based on ICD-10 codes. Of these fractures, 62 were non-ATV related and 35 were ATV related. Charts were reviewed to collect basic demographics, fracture pattern, Gustilo-Anderson classification, procedures performed, operative findings, and complications.
Results:
Our cohort was predominantly male (71% in the ATV group and 76% in the non-ATV group). White race was more common in both the ATV (28 (80%)) and non-ATV (50(78%)) groups. The distribution of AO/OTA fractures was significantly different (p = 0.046), with humerus fractures being more common in the ATV group (8 (22%)) vs. non-ATV group (6 (9.3%)). The ATV group had a higher proportion of more severe type II and III open fractures with 77.1% (n = 27), versus 56% (n = 35) in the non-ATV group (p = 0.020).. Revision and reoperation were more likely in the ATV group (16 (23%)) vs. the non-ATV group (12 (15%)), as was malunion (ATV group 3 (4.3%) Vs. non-ATV 0 (0%)).
Conclusion:
Open fractures resulting from ATV injuries tend to be more complex and have higher rates of revision and malunion. This information supports the large body of evidence on the dangers of ATVs to children and can help guide expectations of both clinicians and family members of patients presenting with these injuries.
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