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Published on: August 17, 2017
Clinical predictors of pathological femoral fractures in children: a retrospective comparative study
Tanja Kraus1, Clemens Clar2, Jürgen Rünk3
1Department of Orthopaedics and Trauma, Pediatric Orthopedic Unit, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Insights
Pediatric femoral fractures can be traumatic or pathological. Pathological fractures in children are more common in older children and result from low-energy trauma, aiding early diagnosis.
Area of Science:
- Pediatric Orthopedics
- Pediatric Radiology
- Pediatric Pathology
Background:
- Femoral fractures in children are uncommon and often trauma-related.
- Some pediatric femoral fractures stem from underlying bone pathology, necessitating early differentiation.
- Identifying predictors for pathological femoral fractures is crucial for timely diagnosis.
Purpose of the Study:
- To identify clinical predictors distinguishing pathological femoral fractures from traumatic ones in children.
- To compare demographic, anatomical, and injury-related variables between pediatric traumatic and pathological femoral fractures.
Main Methods:
- A retrospective single-center study included 432 pediatric patients (0-17 years) with femoral fractures.
- Fractures were classified as traumatic (89.4%) or pathological (10.6%) based on imaging or histopathology.
- Comparative analysis used Mann-Whitney U or chi-square tests for demographic, anatomical, and injury variables.
Main Results:
- Pathological fractures were associated with older age (10.1 vs. 8.3 years) and a unimodal age distribution, unlike the bimodal pattern of traumatic fractures.
- Diaphyseal fractures were common in both groups (approx. 59%).
- Low-energy trauma mechanisms were significantly more frequent in pathological fractures (78.9% vs. 49.5%).
Conclusions:
- Pediatric pathological femoral fractures exhibit distinct age distributions, anatomical locations, and injury mechanisms compared to traumatic fractures.
- Pathological fractures are more likely associated with low-energy trauma.
- Assessing patient age, fracture location, and trauma mechanism aids in early identification of underlying bone pathology.
Background:
Femoral fractures in children are uncommon and are usually trauma-related; however, some occur secondary to underlying bone pathology. Early differentiation between traumatic and pathological fractures is essential to avoid delayed diagnosis. This study aimed to identify clinical predictors associated with pathological femoral fractures in children.
Material And Methods:
In this retrospective single-center comparative study, 432 pediatric patients (0-17 years) with femoral fractures were included. These fractures were classified as traumatic (n = 386, 89.4%; treated between 2011 and 2023) or pathological (n = 46, 10.6%; treated between 2002 and 2021) on the basis of radiological findings, advanced imaging, or histopathological confirmation. Demographic, anatomical, and injury-related variables were compared between the two groups using Mann-Whitney U or chi square tests.
Results:
Patients with pathological fractures tended to be older (10.1 ± 4.3 years versus 8.3 ± 5.9 years, p = 0.090) and age-group distribution differed significantly between the two groups (p < 0.001). Traumatic fractures showed a bimodal age distribution, whereas pathological fractures followed a unimodal pattern. Both groups most commonly sustained diaphyseal fractures (58.7% pathological versus 59.8% traumatic). Low-energy trauma mechanisms were significantly more common in pathological fractures (78.9% versus 49.5%, p = 0.001).
Conclusions:
Pathological femoral fractures in children differ from traumatic fractures with respect to age distribution, anatomical location, and injury mechanism. They are more likely to occur following low-energy trauma and demonstrate a different age distribution to traumatic fractures. Careful assessment of patient age, fracture location, and trauma mechanism may aid in the early identification of underlying bone pathology and support appropriate diagnostic evaluation.
