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Pediatric foot fractures on radiographs: distribution and predictors of surgery

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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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Author notes

  1. Lewis Fanney and Vandan Patel contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Section of Musculoskeletal Imaging, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Lewis Fanney, Vandan Patel, Shahwar M. Tariq, Shijie Hong & Jie C. Nguyen

  2. Eastern Virginia Medical School, Norfolk, VA, USA

    Lewis Fanney

  3. Drexel University College of Medicine, Philadelphia, PA, USA

    Vandan Patel & Shahwar M. Tariq

  4. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA

    Shijie Hong

  5. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Vandan Patel & Richard Davidson

  6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Richard Davidson & Jie C. Nguyen

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  1. Lewis Fanney
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Correspondence to Jie C. Nguyen.

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Fanney, L., Patel, V., Tariq, S.M. et al. Pediatric foot fractures on radiographs: distribution and predictors of surgery. Emerg Radiol (2024). https://doi.org/10.1007/s10140-024-02230-4

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