Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Eastern Virginia Medical School, Norfolk, VA, USA.
Emerg Radiol. 2024 Jun;31(3):341-348. doi: 10.1007/s10140-024-02230-4. Epub 2024 Apr 22.
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.
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.
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.
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.
研究儿童足部骨折在放射学上的分布和特征与年龄和骨骼成熟度的关系，并确定手术的预测因素。
本回顾性研究纳入了 2020 年至 2022 年间接受放射学检查的（≤18 岁）儿童足部骨折患者。回顾电子病历以获取人口统计学和临床数据。收集骨折特征，包括解剖部位、是否存在移位、成角、关节受累，以及如果骨骼未成熟，还包括骺板受累和 Salter-Harris 骨折类型。使用逻辑回归模型确定手术的预测因素。
共纳入 1090 名（596 名男孩，494 名女孩；平均年龄 11.0±4.0 岁）患者，1325 处（59.8%跖骨，33.8%趾骨，6.4%跗骨）骨折。第 1 跖骨骨折在较年幼的儿童中更为常见，而第 2-4 跖骨和第 5 跖骨骨折在较大的儿童中更为常见（中位数年龄：5.9 岁 vs. 10.3 岁和 12.4 岁，p<0.001）。关节内骨折在成熟和成熟骨骼中比在未成熟骨骼中更为常见（25.3%和 20.4% vs. 9.9%，p<0.001）。骺板受累并不常见（162/977，16.6%），最常见的类型是 Salter-Harris Ⅱ型（133/162，82.1%）。少数（47/1090，4.3%）患者需要手术，手术的独立预测因素包括骺板受累（OR=5.12，95%CI：2.48-10.39，p<0.001）、多处骨折（OR=3.85，95%CI：1.67-8.53，p=0.001）、骨折移位（OR=9.16，95%CI：4.43-19.07，p<0.001）和关节受累（OR=2.72，95%CI：1.27-5.72，p=0.008）。使用这些预测因素，手术的可能性范围从 1 个预测因素的 8.0%到 3 个预测因素的 86.7%。
儿童足部骨折的模式因年龄和区域骨骼成熟度而异。骺板受累、多处骨折、骨折移位和关节受累是本研究组中手术的独立预测因素。
