O2108: Phalangeal Fractures in Pediatric Hand Trauma: An Analysis of Epidemiology and Risk Factors

Background: Phalangeal fractures are the most common pediatric hand trauma, but the epidemiology and injury patterns for this group are not well described. This study examines injury characteristics of the pediatric hand trauma population to identify risks associated with phalangeal fractures.

Methods: A retrospective cohort study of pediatric hand trauma patients from 2010-2020 was performed. Patients were included who sustained phalangeal fractures. All charts were abstracted for demographic and clinical details. Geographical and socioeconomic data were obtained from the United States Census Bureau. Summary statistics were calculated, chi-square analysis was performed, and binomial regression was used to compute relative risks (RR). Alpha = 0.05 was used for significance.

Results: 1,311 patients sustained hand trauma, with 754 (57.5%) phalangeal injuries. The most common mechanisms of injury were sports (n=307, 41%), door slams (n=145, 19%), falls (n=84, 11%), and household mishaps (n=78, 10%). 93 patients (12%) required surgery. Compared to all injury mechanisms, violence, motor vehicle accidents, and self-inflicted injuries were associated with a reduced risk of phalangeal fractures (RR 0.22, CI 0.13-0.37, p< 0.001; RR 0.16, CI 0.04-0.60, p=0.002; and RR 0.03, CI 0.01-0.12, p< 0.001, respectively). Among fracture types, buckle fractures, and Salter-Harris fractures were more likely to involve the phalanges (RR 5.58, CI 1.73-18.01, p=0.001; RR 4.73, CI 1.90-11.76, p< 0.001, respectively). Phalangeal fractures were frequently open (n=159, 21%) and were associated with over three times greater risk of open fracture (RR 3.58, CI 2.19-5.86, p< 0.001). Fingertip injuries were the most common concomitant injury in our cohort (n=158, 21%) and were associated with nearly two times greater risk of phalangeal fractures (RR 1.64, CI 1.21-2.21, p< 0.001). Age > 14 years was associated with a reduced risk of phalangeal fractures (RR 0.42, CI 0.34-0.52, p< 0.001), while female gender was associated with an increased risk of phalangeal fractures (RR 1.37, CI 1.13-1.65, p< 0.001). Over a quarter (28.5%) of phalangeal fracture patients had incomes between $43,000 and $53,999 compared to 23.2% of non-phalangeal patients (p=0.042). In contrast, 33.6% of non-phalangeal fracture patients had incomes between $54,000 and $70,999 compared to 27.5% of phalangeal patients (p=0.015). A significant majority of phalangeal patients (92.7%) resided in urban areas compared to 90.5% of non-phalangeal patients (p=0.016).

Conclusion: Our findings illustrate several risk factors for phalangeal fractures in the largest reported cohort in pediatric hand trauma to date. Younger female patients from urban, lower-income households are at the highest risk for phalangeal fractures. In addition, buckle, open, and Salter-Harris fractures are more likely to involve the phalanges. These findings can aid in the emergent triage of phalangeal fractures, allowing for earlier intervention by hand specialists.