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Emergency Radiology

22-04-2024 | Metatarsal Fracture | Original Article

Pediatric foot fractures on radiographs: distribution and predictors of surgery

Authors: Lewis Fanney, Vandan Patel, Shahwar M. Tariq, Shijie Hong, Richard Davidson, Jie C. Nguyen

Published in: Emergency Radiology

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Abstract

Purpose

To examine the distribution and characteristics of pediatric foot fractures on radiographs with respect to age and skeletal maturation, and to identify predictors of surgery.

Methods

This retrospective study included children (≤ 18 years) with foot fractures, who underwent radiographic examinations (2020–2022). Electronic medical records were reviewed to obtain demographic and clinical data. Fracture characteristics, including anatomic location, presence of displacement, angulation, articular involvement, and, if skeletally immature, physeal involvement and Salter-Harris fracture pattern were collected. Logistic regression models were used to identify predictors of surgery.

Results

1,090 (596-boys, 494-girls; mean age, 11.0 ± 4.0 years) patients with 1,325 (59.8% metatarsal, 33.8% phalangeal, and 6.4% tarsal) fractures were included. Fractures of 1st metatarsal were more common among younger children whereas fractures of 2nd-4th and 5th metatarsals were more common among older children (median ages: 5.9 years vs. 10.3 years and 12.4 years, p < 0.001). Intra-articular fractures were more common among maturing and mature than immature bones (25.3% and 20.4% vs. 9.9%, p < 0.001). Physeal involvement was uncommon (162/977, 16.6%) and the most common pattern was Salter-Harris type II (133/162, 82.1%). A minority (47/1090, 4.3%) of patients required surgery and independent predictors of surgery included physeal involvement (OR = 5.12, 95% CI: 2.48–10.39, p < 0.001), multiple fractures (OR = 3.85, 95% CI: 1.67–8.53, p = 0.001), fracture displacement (OR = 9.16, 95% CI:4.43–19.07, p < 0.001), and articular involvement (OR = 2.72, 95% CI:1.27–5.72, p = 0.008). Using these predictors, the likelihood for surgery ranged between 8.0% with 1 and 86.7% with 3 predictors.

Conclusion

Pediatric foot fracture patterns differed based on age and regional skeletal maturation. Physeal involvement, multiple fractures, fracture displacement, and articular involvement were independent predictors of surgery in our study group.
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Metadata
Title
Pediatric foot fractures on radiographs: distribution and predictors of surgery
Authors
Lewis Fanney
Vandan Patel
Shahwar M. Tariq
Shijie Hong
Richard Davidson
Jie C. Nguyen
Publication date
22-04-2024
Publisher
Springer International Publishing
Published in
Emergency Radiology
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-024-02230-4