Pediatric Hand and Wrist Fractures in Osteogenesis Imperfecta: An Analysis of Incidence, Patient-specific Risk
Barkha N Chhabra1, Todd Phillips1, Thomas W Mitchell1
1Department of Orthopaedic Surgery, Baylor College of Medicine.
Insights
Hand and wrist fractures (HWFs) are uncommon in children with osteogenesis imperfecta (OI), occurring in 3.8% of cases. Older children with mild Type I OI are most at risk for these fractures.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Bone Health
Background:
- Osteogenesis imperfecta (OI) commonly causes fractures in children.
- Hand and wrist fractures (HWFs) are rare in OI patients but common in non-OI children.
- Understanding OI HWF incidence and risk factors is crucial.
Purpose of the Study:
- Determine the incidence of HWFs in children with OI.
- Identify patient-specific risk factors for HWFs in OI.
- Compare clinical outcomes of OI HWFs to non-OI HWFs.
Main Methods:
- Retrospective cohort study of OI and non-OI patients with HWFs.
- Database query using ICD-10 codes.
- Analysis of demographics, OI variables, fracture characteristics, and clinical courses.
Main Results:
- OI HWFs occurred in 3.8% of OI patients.
- OI HWF patients were older, shorter, lighter, and less ambulatory than non-OI HWF patients.
- Older age and OI Type I were significant predictors for HWFs in OI patients.
Conclusions:
- OI HWFs are uncommon but have distinct characteristics.
- Older patients with Type I OI are at higher risk.
- Nonoperative management of OI HWFs yields favorable outcomes comparable to non-OI HWFs.
Background:
Children with osteogenesis imperfecta (OI) frequently present with fractures; however, hand and wrist fractures (HWFs), those distal to the radial and ulnar diaphysis, are seldom observed. Yet, HWFs remain among the most common fractures in children with non-OI. The objective of this study was to identify the incidence of OI HWFs. Secondary objectives aimed at identifying patient-specific risk factors for HWFs in OI and comparing clinical courses to non-OI HWFs.
Methods:
A retrospective cohort study was conducted. Database query by ICD-10 codes identified 18 patients with OI HWF, 451 patients with OI without HWFs, and 26,183 patients with non-OI HWF. Power analysis estimated appropriate sample sizes and random sampling was utilized to collect patients. Patient demographics, OI-specific variables, fracture morphology, and fracture clinical courses were recorded. Data were analyzed for patient-specific and fracture-specific factors affecting OI HWF incidence.
Results:
Of patients with OI, 3.8% (18/469) sustained HWFs. Patients with OI HWF were significantly older than patients with OI without HWFs ( P = 0.002) with no differences in height, weight, ethnicity, sex, or ambulatory status. Compared with non-OI HWFs, patients with OI HWF were significantly shorter ( P < 0.001), weighed less ( P = 0.002), and were less likely to be ambulatory ( P < 0.001). OI HWFs were more commonly on the side of hand dominance ( P < 0.001) with transverse patterns ( P = 0.001). OI HWFs were less frequent in the thumb ( P = 0.048) and trended towards significance in the metacarpals ( P = 0.054). All OI HWFs were treated nonoperatively with similar union rates and refracture rates to non-OI HWFs. Multivariate regression showed that older patient age (odds ratio: 1.079, 95% CI: 1.005,1.159, P = 0.037) and OI type I (odds ratio: 5.535, 95% CI: 1.069, 26.795, P = 0.041) were significant prognosticators for HWFs in patients with OI.
Conclusion:
OI HWFs are uncommon (3.8%, 18/469) but specific HWF morphologies and locations are more common in patients with OI; however, these are not pathognomonic. Older patients with mild penetrance of type I OI are at the highest risk for HWFs. OI HWFs do well when managed nonoperatively with noninferior clinical courses compared with non-OI HWFs.
Level Of Evidence:
Level III.
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