Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter
Apurva S Shah1, Ryan H Guzek1, Mark L Miller2
1Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Pediatric distal radius fractures are more common in males and occur during spring, often from high-energy falls or sports. Physeal fractures affect older children, while torus and bicortical fractures are seen in younger ones.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Epidemiology
Background:
- Distal radius fractures account for over 25% of pediatric fractures.
- Existing research is limited by retrospective, single-center studies, often including adults.
- A need exists for contemporary epidemiological data on pediatric distal radius fractures.
Purpose of the Study:
- To describe the contemporary epidemiology of pediatric distal radius fractures.
- To utilize prospectively collected data from a multicenter registry.
- To identify demographic, injury, and treatment characteristics.
Main Methods:
- Prospective longitudinal cohort study of 1951 patients aged 4-18 years.
- Data collected from June 2018 to December 2019 across 4 tertiary pediatric centers.
- Inclusion criteria excluded bilateral fractures, polytrauma, and re-fractures; data included demographics, injury mechanisms, fracture types, and treatments.
Main Results:
- Most fractures occurred in males (61.3%) during high-energy falls (33.5%) or sports (28.4%), predominantly in spring.
- Torus fractures (44.0%) were most common, followed by bicortical (31.3%) and physeal (21.0%) fractures.
- Physeal fractures (Salter-Harris II) occurred in older children (mean 11.6 years) compared to torus/bicortical fractures (mean 9.4-9.6 years).
Conclusions:
- Pediatric distal radius fractures show a male predominance and seasonal incidence (spring).
- High-energy falls and sports are primary causes.
- Fracture type correlates with age, with physeal fractures in older children and torus/bicortical in younger ones.
Introduction:
More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry.
Methods:
Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed.
Results:
A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male ( P <0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P <0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P <0.001), obese (25.3% vs. 17.2%; P <0.001), and have bicortical fractures (62.2% vs. 14.5%; P <0.001).
Conclusions:
Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children.
Level Of Evidence:
Level I-prognostic.
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