Pediatric metacarpal and metatarsal fracture in pediatric emergency department

AIM: This retrospective study analyzes the epidemiological characteristics, trauma mechanisms, and anatomical distribution of metacarpal and metatarsal fractures in pediatric patients presenting to a pediatric emergency department (PED) due to hand and foot trauma. METHOD: We retrospectively evaluated 278 patients diagnosed with metacarpal or metatarsal fractures who presented to the PED between January 2019 and May 2024. Patient data, including age, gender, trauma mechanism, fracture location and type, and treatment methods, were analyzed using SPSS 22.0. A p-value of < 0.05 was considered statistically significant. RESULTS: Among the 278 patients under 18 years old, 63.3% had metacarpal fractures and 36.7% had metatarsal fractures. The majority were male (80.2%) and ranged in age from 10 to 15. Falls were the most common trauma mechanism. The fifth metacarpal and metatarsal bones were the most frequently fractured sites. Most fractures were managed conservatively with resting splints; only one open fracture required surgical intervention. Violence-related fractures were more common in adolescents older than 15 years, while falls predominated in younger children. In multivariable logistic regression, metacarpal fractures were independently associated with male sex, spring season, swelling at presentation, violence-related mechanisms, and trauma occurring in school, garden/street/park settings (all p < 0.05), with good model explanatory performance (Cox & Snell R2 = 0.505; Nagelkerke R2 = 0.690). Metatarsal fractures were significantly associated with age < 5 years, motor vehicle tire–crush injuries, ball sports, proximal localization, and 1st/5th bone involvement (all p < 0.05). Confidence intervals were wide for some predictors, suggesting sparse data in certain categories. CONCLUSION: Metacarpal and metatarsal fractures in children predominantly occur in males aged 10–15 years and are frequently caused by low-energy falls and violence-related trauma. These findings emphasize the importance of targeted preventive measures, including environmental safety improvements and violence reduction programs, to reduce the incidence of such fractures in the pediatric population.