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Pediatric foot fractures on radiographs: distribution and predictors of surgery
Lewis Fanney1,2, Vandan Patel1,3,4, Shahwar M Tariq1,3
1Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Purpose:
To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery.
Methods:
This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020-2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery.
Results:
1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3% and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%) of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95% CI: 2.48-10.39, p < 0.001), multiple fractures (OR = 3.85, 95% CI: 1.67-8.53, p = 0.001), fracture displacement (OR = 9.16, 95% CI:4.43-19.07, p < 0.001), and articular involvement (OR = 2.72, 95% CI:1.27-5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors.
Conclusion:
Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.
