Higher Child Opportunity Index is Associated With Supracondylar Humerus Fracture Rates in the Pediatric Population

Supracondylar humerus (SCH) fractures are the most common pediatric elbow fractures. The Child Opportunity Index (COI) 2.0 is an aggregate measure designed to reflect community features that can impact child well-being. We aimed to investigate the relationship between institution-captured SCH fracture rates and COI level.

We retrospectively queried the surgical database of a level 1 pediatric trauma center in a medium-sized metropolitan area by CPT code. We identified patients (aged 18 y or younger) who underwent surgical fixation for SCH fracture from 2010 to 2022. Patient residential ZIP codes were used to assign COI levels to each patient, and fracture rates were examined across COI strata. Associations between obesity and fracture classification and treatment, as well as insurance status and treatment, were assessed.

We reviewed the charts of 2097 patients who underwent surgical management for SCH fracture. The risk of SCH fracture increased by 9% for each increase in COI quintile (P<0.001), and this risk remained significant after adjusting for race (P=0.046). Black patients in high COI neighborhoods experienced increased rates of fracture (P=0.040) relative to White patients. White and Hispanic patients were more likely to undergo open reduction in the general (P=0.045) and metropolitan samples (P=0.037). Obese patients were more likely to undergo open reduction in the general (P=0.029) and metropolitan sample (P=0.003) and were more likely to undergo open reduction in the metropolitan sample (P=0.010).

Those living in higher COI ZIP codes experienced higher rates of SCH fracture. We found this effect to be stronger on the Black population, so that Black patients in high COI neighborhoods experienced increased rates. Obese patients were more likely to present with open fractures, and obese patients in our metropolitan area were more likely to undergo open reduction. This study identifies the relationship between SCH fracture rates and treatment and social determinants of health, improving our understanding of risk factors for common pediatric fractures and their management.

Level II-prognostic study.