229 - Characterization of Fractures and Their Etiology in Pre- and Early Ambulatory Children

Poster Number: 229
Publication Number: 229.402

Priyanka P. Patel, Rady Children's Hospital San Diego, San Diego, CA, United States; Kristen Wigby, University of California, San Diego School of Medicine, San Diego, CA, United States; Kathryn Hollenbach, UCSD/Rady Children's Hospital-San Diego, San Diego, CA, United States; Cynthia Kuelbs, Rady Children's Hospital San Diego, San Diego, CA, United States; Lynne M. Bird, University of California, San Diego School of Medicine, San Diego, CA, United States; Marilyn Kaufhold, Rady Children's Hospital San Diego, San Diego, CA, United States; Vidyadhar V. Upasani, University of California, San Diego School of Medicine, San Diego, CA, United States

Background:
As children become ambulatory, the incomplete development of motor and balance skills may predispose them to injury. Given that there is no universally accepted approach to evaluation of young children who present with fractures, this allows for the potential for unrecognized or delayed diagnosis of non-accidental trauma, a genetic condition, or a metabolic disorder.

Objective:
The purpose of this study was to identify fracture etiology and determine the incidence of metabolic and genetic disorders that predispose to fracture in young children.

Design/Methods: A retrospective chart review was completed of a population-based sample from a regional pediatric health care facility. All encounters for fractures in Epic between July 2011 and December 2012 for children 18 months and younger were analyzed by a team of reviewers and revised with specialty faculty if required. Etiologies were classified as Accidental, Inflicted, Genetic/Metabolic Disorder, Other Predisposing Factor, Undetermined, and Birth Trauma. Exclusion criteria included dental fractures, imaging without evidence of fracture, or imaging not associated with an encounter. Statistical analysis was completed using Stata 16 (College Station, TX). Fisher’s Exact Test was used for comparisons of demographic and clinical factors among etiologic groups. Cases of Undetermined etiology were excluded from group-wise comparisons.

Results:
754 encounters were analyzed. Etiologies of fractures by research team review were as follows: 640 (84.8%) cases of Accidental injury; 39 (5.2%) of Inflicted Injury; 6 (0.8%) due to a Genetic disorder known to predispose to fracturing; 2 (0.26%) due to a Predisposing Factor; 54 (7.2%) of Undetermined cause; and 13 (1.7%) due to Birth-related Trauma. The genetic disorders included hypophosphatasia, osteopetrosis, osteogenesis imperfecta, and hereditary sensory and autonomic neuropathy. Analysis of additional identifying characteristics, including presenting features of each fracture etiology, will be outlined. Interestingly, in 196 cases (25.9%), there was discrepancy between the initial clinical impression and the research team review of fracture etiology. Features of these discrepancies will also be presented.
Conclusion(s): A significant number of children with metabolic and genetic disorders presented with fractures in early age. The discrepancy between initial and review team etiologies requires further analysis into factors that may have affected these conditions.
Priyanka P. Patel - CVPriyanka Patel CV.pdf