Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：探讨儿童足部骨折在X线片上的年龄和骨骼成熟的分布和特征，并确定手术的预测因素。
方法：这项回顾性研究包括足骨折患儿（≤18岁），谁接受了影像学检查（2020-2022年）。审查电子病历以获得人口统计学和临床数据。断裂特征,包括解剖位置,流离失所的存在，成角,关节受累,and,如果骨骼不成熟，收集了植骨受累和Salter-Harris骨折类型。使用Logistic回归模型来确定手术的预测因素。
结果：1,090（596名男孩，494-女孩；平均年龄，11.0±4.0岁）患者为1,325例（59.8％meta骨，33.8%指骨,包括6.4%的tal骨）骨折。第1跖骨骨折在年龄较小的儿童中更常见，而第2-4和5跖骨骨折在年龄较大的儿童中更常见（中位年龄：5.9岁与10.3年和12.4年，p<0.001)。在成熟和成熟的骨骼中，关节内骨折比未成熟的骨骼更常见（25.3％和20.4％vs.9.9%，p<0.001)。Physeal受累不常见（162/977，16.6％），最常见的模式是Salter-HarrisII型（133/162，82.1％）。少数患者（47/1090，4.3％）需要手术，手术的独立预测因素包括植物受累（OR=5.12，95％CI：2.48-10.39，p<0.001），多发性骨折(OR=3.85,95%CI:1.67-8.53,p=0.001),骨折位移（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）。使用这些预测因子，手术的可能性介于8.0%和1和86.7%之间,有3个预测因子.
结论：儿童足部骨折类型因年龄和区域骨骼成熟而异。Physeal参与，多处骨折,断裂位移,和关节受累是研究组手术的独立预测因素.
方法：这项回顾性研究包括足骨折患儿（≤18岁），谁接受了影像学检查（2020-2022年）。审查电子病历以获得人口统计学和临床数据。断裂特征,包括解剖位置,流离失所的存在，成角,关节受累,and,如果骨骼不成熟，收集了植骨受累和Salter-Harris骨折类型。使用Logistic回归模型来确定手术的预测因素。
结果：1,090（596名男孩，494-女孩；平均年龄，11.0±4.0岁）患者为1,325例（59.8％meta骨，33.8%指骨,包括6.4%的tal骨）骨折。第1跖骨骨折在年龄较小的儿童中更常见，而第2-4和5跖骨骨折在年龄较大的儿童中更常见（中位年龄：5.9岁与10.3年和12.4年，p<0.001)。在成熟和成熟的骨骼中，关节内骨折比未成熟的骨骼更常见（25.3％和20.4％vs.9.9%，p<0.001)。Physeal受累不常见（162/977，16.6％），最常见的模式是Salter-HarrisII型（133/162，82.1％）。少数患者（47/1090，4.3％）需要手术，手术的独立预测因素包括植物受累（OR=5.12，95％CI：2.48-10.39，p<0.001），多发性骨折(OR=3.85,95%CI:1.67-8.53,p=0.001),骨折位移（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）。使用这些预测因子，手术的可能性介于8.0%和1和86.7%之间,有3个预测因子.
结论：儿童足部骨折类型因年龄和区域骨骼成熟而异。Physeal参与，多处骨折,断裂位移,和关节受累是研究组手术的独立预测因素.
