Intentional Hand Fractures are Associated with Future Psychiatric Conditions in Youth

Hand fractures are a common complaint in pediatric patients. The association between pediatric hand fractures and subsequent engagement with mental health and addictions (MHA) services remains unstudied. This study investigated the relationship between hand injury mechanisms and future presentation to MHA services.

A retrospective cohort study was conducted off all patients presenting to a pediatric plastic surgery clinic from 2012 to 2017. Data collected included demographics, fracture mechanism and location, and subsequent presentation to MHA services. Stepwise logistic regression models were employed to assess risk factors for future presentation to MHA and diagnosis of psychiatric illnesses.

A total of 1184 patients presented with pediatric hand fractures. Most injuries were accidental (87.9%), with sports being the most common cause (52.4%). Intentional injuries accounted for 12.2% of cases, primarily due to punching a solid object (53.5%) or another individual (45.1%). Patients with intentional injuries were significantly older (14.1 vs 11.8 years, p<0.001) and predominantly male (93.1% vs 66.2%, p <0.001) compared to patients with accidental injuries. Overall, 12.2% of patients were assessed by MHA services, with a relative risk of 5.59 for those with intentional injuries. The most diagnosed psychiatric illness was ADHD (56.7%). Intentional injury mechanism was significantly associated with a future diagnosis of ADHD (p<0.001), generalized anxiety disorder (p=0.022), major depressive disorder (p=0.012), and substance use disorder (p<0.001).

Intentional hand fractures in the pediatric population are strongly associated with future MHA assessment. These findings support early screening and referral to MHA services when intentional injury mechanism is identified.