OTA 2008 Posters

Scientific Poster #108 Pediatrics OTA-2008

Behavioral Risk Factors in Pediatric Hand Fractures

Syed Gillani, MD (n); Allison Wiliams, PhD (n); Kagan Ozer, MD (n);
Department of Orthopaedics, University of Colorado, School of Medicine,
Denver Health Medical Center, Denver, Colorado, USA

Purpose: Aggressive and violent behavior is a significant public health problem worldwide. In the United States, physical assault is the sixth leading cause of nonfatal injury in 15- to 19-year-olds and the seventh leading cause in 10- to 14-year-olds. Among injuries caused by altercation, the hand is the most frequently injured part. Factors resulting in violent behavior vary, however. Psychiatric illnesses are becoming more commonly recognized as a cause of violence in the pediatric population. In this study, we aimed to assess (1) the link between the pediatric fractures and psychopathology and (2) the prevalence of injury recidivism among those who have psychopathology.

Methods: We retrospectively reviewed 244 patients treated at a Level 1 hospital between 1997 and 2006. Age, gender, past medical and psychiatric history, as well as type, etiology, and treatment of hand injuries were recorded for analysis. Fisher exact tests were performed to evaluate the association between metacarpal fractures, psychiatric history, and injury related to altercation/fight. Independent samples t tests were performed to compare differences in age by psychiatric history, injury etiology, and fracture type (metacarpal fracture vs other). Statistical significance was declared at P <0.05.

Results: The mean age was 12.9 (standard deviation = 4.8) years. 26 fractures (11.2%) were open and 206 (88.4%) were closed. Fracture diagnoses were as follows: 111 (48.9%) phalangeal fractures, 93 (41%) metacarpal fractures, 14 (6.2%) wrist fractures, and 9 (4.0%) distal radius fractures. Fractures were attributed to motor vehicle accidents in 44 cases (18.9%), sports activities in 53 (22.7%), fall on outstretched hand in 38 (16.3%), altercation/fight in 60 (25.8%), and other in 38 (16.3%). 11 patients (4.7%) had a history of medical problems, 34 (65.4%) psychiatric problems, and 7 (13.5%) surgical interventions. Patients with positive psychiatric history were more likely to have a metacarpal fracture (P = 0.05). Of 60 persons whose injuries were due to an altercation/fight, 21 (35.0%) had a documented psychiatric issue, significantly more than those who did not have that history (P <0.001). 39 patients (68.4%) with injuries related to an altercation had metacarpal fractures while 18 (31.6%) had another type of hand fracture (P <0.001). More than half (52.9%, n = 18) of patients with a positive psychiatric history had a subsequent injury. whereas only 14.6% (n = 29) of patients negative for psychiatric issues had a subsequent injury. The association between psychiatric history and subsequent injury was statistically significant (P <0.001). The most common psychiatric disorders were attention deficit hyperactivity disorder, depression, and substance abuse.

Conclusion and Significance: Our findings indicate that a large percentage of children with metacarpal fractures due to altercation were more likely to have a psychiatric illness and repeated hand injuries. A psychiatric assessment should be included when evaluating children presenting with a boxer’s fracture.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.