Lim Rodrick K, Gerson Bridgette, Seabrook Jamie A, Reardon Jaime, Poonai Naveen
Pediatr Emerg Care. 2018 Apr;34(4):233-236. doi: 10.1097/PEC.0000000000001463.
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.
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.
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.
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.
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.
儿童前足骨折占儿童骨折的6%至10%，尽管大多数骨折通过支持性治疗可愈合，但并发症可能导致疼痛和残疾。此前尚无针对儿童的研究基于初始评估特征评估急诊科的并发症风险。
本研究旨在确定增加小儿前足骨折并发症发生率的影像学和临床变量。这可能有助于急诊医生转诊需要更全面随访或手术干预的患者。
我们对伦敦卫生科学中心儿童医院儿科急诊科6年内首次就诊的497例前足骨折进行了评估。我们收集了诸如成角程度、移位情况、并发骨折数量等变量，以及年龄和性别等人口统计学数据。然后，我们通过查阅每位患者的病历确定与并发症相关的变量。
总体而言，并发症发生率为6.4%。分析确定性别是并发症的重要预测因素。女性虽然约占样本的三分之一，但在并发症结局的病例中占近三分之二（P = 0.001；优势比[OR]，4.67）。骨折数量增加也具有显著意义（P = 0.01；OR，2.41），年龄增长同样如此（P = 0.01；OR，1.17），以及选择返回急诊科的患者（P < 0.05；OR，5.282）。外侧成角/移位和前后成角/移位与并发症增加无关。
识别诸如女性、年龄增长、多处骨折以及返回急诊科复诊等特征，可能有助于指导急诊医生确定应将哪些患者转诊接受专科护理。
