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Pediatric Off-Road Vehicle Injuries: Side-by-Sides Worse for the Upper Extremity
Mitchell A Solano1, Gunner R Gilbert1, Akshay R Krishnan1
1From the Departments of Orthopaedic Surgery.
Insights
Pediatric fractures from side-by-side (SXS) vehicles are more often open and require surgery than those from all-terrain vehicles (ATVs). Younger children (<13) also had higher surgery rates for upper extremity fractures from off-road vehicles (ORVs).
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Off-Road Vehicle Safety
Background:
- Off-road vehicles (ORVs), including side-by-side (SXS) and all-terrain vehicles (ATVs), are frequently involved in pediatric injuries.
- Existing literature often groups SXS and ATVs together, potentially masking distinct injury patterns.
- Understanding differences in pediatric upper extremity (UE) fractures between ORV types is crucial for targeted prevention and treatment.
Purpose of the Study:
- To investigate and compare pediatric upper extremity (UE) fracture patterns and injury severity between different types of off-road vehicles (ORVs).
- To analyze differences in fracture characteristics, surgical intervention rates, and injury severity scores (ISS) based on ORV type.
Main Methods:
- A retrospective review of 157 pediatric patients (0-17 years) with UE fractures from ORV accidents (2011-2021) using a state trauma repository.
- Fracture types and procedures were identified via ICD coding and manual chart review/phone calls.
- Comparison of fracture characteristics, surgery rates, and ISS between ATVs, SXSs, and other ORVs, with significance set at P < 0.05.
Main Results:
- Side-by-side (SXS) vehicle injuries showed significantly higher rates of open fractures (42%) compared to all-terrain vehicles (ATVs) (7%) and other ORVs (16%).
- SXS-related fractures required surgery more often (70%) than ATV (41%) or other ORV fractures (34%).
- SXS drivers sustained left-sided injuries (71%), while passengers had right-sided injuries (85%); younger children (<13 years) had higher surgery rates (59%).
Conclusions:
- Pediatric upper extremity fractures from SXS vehicles are more likely to be open and necessitate surgical intervention compared to ATVs and other ORVs.
- Distinct injury patterns exist for SXS drivers versus passengers, with younger patients (<13 years) requiring more surgeries.
- While ISS did not differ significantly, the type and severity of fractures vary considerably by ORV type, highlighting the need for specific safety measures.
Objectives:
Side-by-side (SXS) and all-terrain vehicles (ATVs) are different off-road vehicles (ORVs) but often categorized together in the literature. We hypothesized pediatric upper extremity (UE) fracture patterns and injury severity scores (ISS) differ between ORV types.
Methods:
The authors' home-state trauma repository identified 157 pediatric patients aged 0 to 17 years with UE fractures after ORV accidents during 2011-2021. ORV injuries, fracture type, and procedures were identified using International Classification of Diseases, 9th Revision and 10th Revision coding followed by manual chart review or phone calls. We identified specific ORV type, driver/passenger status, and restraint use to compare differences between fracture characteristics, number of surgeries, and ISS. Groups were compared for differences at P < 0.05 significance.
Results:
Among 157 ORV injuries, 75 resulted from ATVs (48%), 50 SXSs (32%), and 32 from all other vehicles (20%). Average age was 12 years, and 49% (n = 77) required surgery. SXS injuries had significantly higher open fracture rates (42%, n = 21) compared with ATVs (7%, n = 5) and all other ORV types (16%, n = 5; P < 0.0001). Seventy percent of fractures (n = 35) sustained after SXS accidents required surgery compared with 41% (n = 31) for ATVs and 34% (n = 11) for all other ORV types ( P < 0.001). SXS drivers had 71% left-sided injuries, whereas 85% passengers had right-sided injuries ( P < 0.0001). Patients younger than 13 years (n = 73) had significantly higher surgery rates (59%) compared with 40% for those 13 years and older (n = 84; P = 0.02). There were no significant differences in mean ± SD ISS between ATV (8 ± 6), SXS (8 ± 6), and other vehicles (7 ± 4; P = 0.34).
Conclusions:
UE fractures caused by SXS were more likely to be open and require surgery compared with ATVs and other ORVs. SXS drivers were more likely to sustain left-sided injuries, whereas passengers had significantly higher right-sided injuries. Patients younger than 13 years were more likely to require surgery compared with teenagers.
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