Open Fractures Beyond Long Bones: Rethinking Age-Dependent Injury Mechanisms and Anatomical Patterns in Pediatric...

Background: Open fractures are traditionally associated with high-energy trauma, such as falls and traffic accidents, in healthy adults. However, the epidemiological characteristics of such injuries in children and adolescents remain incompletely defined. Most studies focus on long-bone injuries, while comprehensive epidemiological data across all anatomical regions are limited. This study aimed to analyze and provide an overview of age-dependent patterns of injury mechanisms and anatomical distribution in pediatric open fractures. Methods: This retrospective cohort study included all open fractures in patients aged 0-18 years treated at a level-I trauma center between 2002 and 2023. Demographic characteristics, injury mechanisms, anatomical distribution, treatment strategies, and complications were analyzed. Results: A total of 814 patients with 849 open fractures were included (mean age 10.5 ± 5.6 years; 67.7% male). Injury mechanisms differed significantly across age groups (p < 0.001), shifting from falls in infants and leisure-related injuries in younger children toward sports-related, traffic-related, and confrontation-related injuries in adolescents. Anatomical distribution also varied significantly with age (p < 0.001). Upper-extremity fractures predominated in younger children, whereas craniofacial fractures increased with age and became the leading anatomical region among adolescents aged 16-18 years (57.7%). Lower-extremity fractures also increased with age, although they accounted for a smaller proportion of fractures overall (14.4%). Across the entire cohort, open fractures most frequently involved the upper extremity (50.1%), followed by the craniofacial region (35.3%). Finger fractures represented the most common injury location (36.3%), followed by nasal fractures (20.6%). Most fractures were managed conservatively (66.8%), while 33.2% underwent surgical treatment. Complications were documented in 15.2% of patients, with surgical treatment required in 50.0% of these cases; septic complications mainly consisted of pin tract infections associated with external fixation. Persistent sequelae occurred in 4.9%, mainly including range-of-motion limitations and pain. Conclusion: Pediatric open fractures showed an age-dependent epidemiological pattern, with upper-extremity injuries predominating in younger children and craniofacial injuries increasing among adolescents. The substantial proportion of craniofacial and distal extremity fractures highlights the importance of considering the full anatomical spectrum of pediatric open fractures beyond long-bone injuries alone.