The Incidence of Pediatric Tibial Spine Fractures Is Greater and Peaks Later in Male Patients

Christopher J Defrancesco,Alexandra Tananbaum,Drake G Lebrun,Peter D Fabricant

doi:10.1016/j.asmr.2021.12.005

Christopher J Defrancesco, Alexandra Tananbaum + Show 2 more

Open Access

https://doi.org/10.1016/j.asmr.2021.12.005

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Abstract

PurposeTo use government-curated databases to produce incidence estimates for pediatric tibial spine fractures (TSFs) by age and sex. This study also describes the relative frequency of operative versus nonoperative management for TSFs by age and sex.MethodsUS Healthcare Cost and Utilization Project databases were used to identify cases of TSF among patients aged 7 to 18 years in the year 2016. Patient-linked deidentified data from New York, Maryland, and Florida were gathered from state databases, and repeat visits by the same patient were collapsed into individual records. TSF incidence was then calculated, with U.S. census data used to determine the number of children at risk. The proportion of cases treated nonoperatively was determined based upon procedural codes.ResultsIn New York, Florida, and Maryland, 185 cases of TSF were found. Male patients accounted for 69.7% of cases. Incidence peaked at 9.3 per 100,000 at age 14 years for male patients and at 3.4 per 100,000 at age 9 years for female patients. In total, 57.9% of TSF cases were treated nonoperatively. The overall incidence of TSF was 2.8 cases per 100,000 for people aged 7 to 18 years.ConclusionsThis study confirms a difference in incidence by sex for pediatric TSFs, with male patients having a greater peak incidence that also occurs at an older age. Most cases in this study were treated nonoperatively.Clinical RelevanceDue to the relative infrequency of TSFs in the pediatric population, there is a limited understanding of the epidemiology and treatment of these fractures. The use of data from a large patient database may provide valuable epidemiologic information about this uncommon injury.

Highlights

To use government-curated databases to produce incidence estimates for pediatric tibial spine fractures (TSFs) by age and sex
A recent study identified more than 800 cases of TSFs from a database of privately insured patients and showed that the injury was more common in male than female patients
The incidence of TSFs peaked for male patients at age 14 (9.3 per 100,000)

Summary

Methods

Institutional review board approval was not required for this retrospective study of deidentified data. CPT, Current Procedural Terminology; ICD, International Classification of Diseases; SASD, State Ambulatory Surgery and Services Databases; SEDD, State Emergency Department Databases; TSF, tibial spine fracture. Understanding that the International Classification of Diseases, Tenth Revision (ICD-10), created a specific diagnosis code for TSF that previously did not exist, the year 2016 was chosen for the analysis This was the first year that the SEDD and SASD reported ICD-10 codes and the most recent year with data available for all 3 chosen states. The authors used ICD-10 and Current Procedural Terminology (CPT) codes to find cases of tibial spine fractures from the SEDD and SASD. ICD, International Classification of Diseases; PCS, Procedure Coding System; SID, State Inpatient Database; TSF, tibial spine fracture. The threshold for statistical significance was set at P .05, and all comparisons were 2-tailed

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