Peddada Kranti V, Sullivan Brian T, Margalit Adam, Sponseller Paul D
Department of Pediatric Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Pediatr Orthop. 2018 Apr;38(4):e207-e212. doi: 10.1097/BPO.0000000000001137.
It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1).
We reviewed records of 29,101 pediatric patients with fractures from 2003 through 2015. We included patients with closed fractures not resulting from motor vehicle accidents, gunshot wounds, nonaccidental trauma, or bone lesions. Patients with OI of any type were identified through International Classification of Diseases-9 code. We randomly sampled 500 pediatric patients in whom OI was not diagnosed to obtain a control (non-OI) group. We reviewed age at time of fracture, sex, fracture type, laterality, and bone and bone region fractured. Bisphosphonate use and OI type were documented for OI patients. Subanalysis of patients with type-1 OI was performed. The Fisher exact and χ tests were used to compare fracture rates between groups. P<0.05 was considered significant. Positive likelihood ratios for OI were calculated by fracture pattern.
The non-OI group consisted of 500 patients with 652 fractures. The OI group consisted of 52 patients with 209 fractures. Non-OI patients were older at the time of fracture (mean, 9.0±5.0 y) than OI patients (mean, 5.5±4.4 y) (P<0.001). OI patients had more oblique, transverse, diaphyseal, and bilateral long-bone fractures than non-OI patients (all P<0.001). Non-OI patients had more buckle (P=0.013), metaphyseal (P<0.001), and physeal (P<0.001) fractures than OI patients. For patients with type-1 OI and long-bone fractures (n=18), rates of transverse and buckle fractures were similar compared with controls. Transverse humerus (15.2), olecranon (13.8), and diaphyseal humerus (13.0) fractures had the highest positive likelihood ratios for OI, and physeal (0.09) and supracondylar humerus (0.1) fractures had the lowest.
Transverse and diaphyseal humerus and olecranon fractures were most likely to indicate OI. Physeal and supracondylar humerus fractures were least likely to indicate OI. Radiographic fracture pattern is useful for estimating likelihood of OI.
Level III.
评估小儿骨折由成骨不全（OI）引起的可能性非常重要，尤其是最轻微的成骨不全类型（1型）。
我们回顾了2003年至2015年期间29101例小儿骨折患者的记录。我们纳入了非因机动车事故、枪伤、非意外创伤或骨病变导致的闭合性骨折患者。通过国际疾病分类第9版代码识别任何类型的OI患者。我们随机抽取500例未诊断为OI的小儿患者以获得对照组（非OI组）。我们回顾了骨折时的年龄、性别、骨折类型、骨折部位及骨折的骨骼和骨区域。记录了OI患者的双膦酸盐使用情况和OI类型。对1型OI患者进行了亚分析。采用Fisher精确检验和χ检验比较组间骨折发生率。P<0.05被认为具有统计学意义。通过骨折类型计算OI的阳性似然比。
非OI组由500例患者组成，共652处骨折。OI组由52例患者组成，共209处骨折。非OI患者骨折时的年龄（平均9.0±5.0岁）大于OI患者（平均5.5±4.4岁）（P<0.001）。与非OI患者相比，OI患者有更多的斜形、横行、骨干和双侧长骨骨折（均P<0.001）。非OI患者的青枝骨折（P=0.013）、干骺端骨折（P<0.001）和骨骺骨折（P<0.001）比OI患者更多。对于1型OI和长骨骨折患者（n=18），与对照组相比，横行和青枝骨折的发生率相似。肱骨横行骨折（15.2）、鹰嘴骨折（13.8）和肱骨干骨折（13.0）的OI阳性似然比最高，骨骺骨折（0.09）和肱骨髁上骨折（0.1）的阳性似然比最低。
肱骨横行和骨干骨折以及鹰嘴骨折最有可能提示OI。骨骺和肱骨髁上骨折最不可能提示OI。X线骨折类型有助于评估OI的可能性。
三级。
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