281 Incidence and Predictors of Elbow Injury in Children With Distal Forearm Fractures

Abstract

Pediatric distal forearm fractures are one of the most common injuries seen in the emergency department. Providers are often advised to radiograph the joint above and the joint below the fracture site to assess for concurrent injury, even if there are no historical or physical exam findings suggestive of an additional injury at those sites. Despite this teaching, there is little evidence to suggest that elbow injuries are common in children with distal forearm fractures. Similarly, there is little data that help the clinician predict which children are at higher risk for co-injury. We performed a cross-sectional study, using the 2011 National Emergency Department Sample (NEDS) dataset. Children age 2 to 17 years with any of the 19 International Classification of Disease Ninth Revision (ICD-9) codes corresponding to forearm fractures of the distal radius and/or ulna were included in the study. The primary outcome of interest was an “elbow” injury, defined as any of the 40 ICD-9 codes for proximal radius, proximal ulna, or distal humeral fracture. Multivariable logistic regression was performed using patient demographics, Injury Severity Score, mechanism of injury, and underlying medical conditions. 54,262 children with distal forearm injuries were included, 99.3% of which were closed fractures. Of all patients with distal forearm fractures, only 0.8% (n=462) had an elbow injury. Supracondylar fractures of the humerus were the most common elbow injury seen (48.2%). Children were more likely to have a co-injury if they were younger (7.5 years vs. 9.6 years p<0.01), female (50.0% vs. 36.2%)), injured via fall (78.5% vs. 69.3% p<0.01), had a higher Injury Severity Score (4.5 vs. 4.1 p<0.01), or were admitted for their injuries (20.8 vs. 1.6% p<0.01). In the adjusted model, only age and disposition were predictors of co-injury. Isolated buckle fractures of the ulna were associated with a statistically significant increase in the odds of concurrent elbow injury (OR 5.34, 95% CI 1.69-12.93). An isolated buckle fracture of the radius and Colles-type fracture of the radius were protective against elbow injury (OR 0.32, 95% CI 0.19-0.54 and OR 0.37, 95% CI 0.21-0.62, respectively). Children with distal forearm fractures very rarely have concurrent elbow injuries. These injuries are more likely in younger patients and those admitted to the hospital.