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Article
Pediatric Forefoot Fractures: Assessment of Fracture Patterns and Predictors of Complicated Outcome
Pediatric Emergency Care
  • Rodrick Lim, Western University
  • Bridgette Gerson, Western University
  • Jamie A Seabrook, Western University
  • Jaime Reardon, Western University
  • Naveen Poonai, Western University
Document Type
Article
Publication Date
4-1-2018
URL with Digital Object Identifier
https://doi.org/10.1097/PEC.0000000000001463
Disciplines
Abstract

Background

Forefoot fractures account for 6% to 10% of fractures in children, and although the majority heals with supportive treatment, complications may lead to pain and disability. No previous study in children has evaluated complication risk in the emergency department based on initial assessment characteristics.

Study Objectives

The study aim was to identify the radiological and clinical variables that increase the complication rate of pediatric forefoot fractures. This may help emergency physicians refer patients who require more thorough follow-up or surgical intervention.

Methods

We evaluated 497 forefoot fractures on initial presentation to a pediatric emergency department at the Children's Hospital at London Health Science Centre over a 6-year period. We collected variables such as degree of angulation, displacement, number of concurrent fractures, and demographic data such as age and sex. We then determined the variables associated with complications by reviewing each patient's chart.

Results

Overall, there was a 6.4% complication rate. Analysis identified sex as an important predictor of complications. Females, although representing approximately one third of the sample, represented nearly two thirds of the cases with complicated outcomes (P = 0.001; odds ratio [OR], 4.67). Increased number of fractures was also significant (P = 0.01; OR, 2.41) as was increasing age (P = 0.01; OR, 1.17) and patients who chose to return to the emergency department (P < 0.05; OR, 5.282). Lateral angulation/displacement and anteroposterior angulation/displacement were not associated with increased complications.

Conclusion

Identifying features, such as female sex, increasing age, multiple fractures, and return to emergency departments for repeat visits, may help guide the emergency physician on whom to refer for specialized care.

Notes

Article available at Pediatric Emergency Care, Vol. 34(4).

https://doi.org/10.1097/PEC.0000000000001463

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Citation Information
Rodrick Lim, Bridgette Gerson, Jamie A Seabrook, Jaime Reardon, et al.. "Pediatric Forefoot Fractures: Assessment of Fracture Patterns and Predictors of Complicated Outcome" Pediatric Emergency Care Vol. 34 Iss. 4 (2018) p. 233 - 236
Available at: http://works.bepress.com/rodrick-lim/20/