Hand Injuries in the Polish Silesian Paediatric Population—An Exploratory Cross-Sectional Study of Post-Traumatic X-rays

Abstract

Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. Not only are they a significant factor in health care costs, but they may also lead to detrimental and long-term consequences for the patient. The discrepancy observed between the published studies suggests a geographical variation in their epidemiology. The aim of this study is to determine the localisation of injuries and fractures involving the hand in the paediatric population of the Polish Silesia region. This exploratory cross-sectional study involved 1441 post-traumatic hand X-ray examinations performed at the Department of Diagnostic Imaging of the John Paul II Upper Silesian Child Health Centre in Katowice between January and December 2014. Materials and Methods: The study group consisted of 656 girls and 785 boys who were 11.65 ± 3.50 and 11.51 ± 3.98 years old, respectively (range: 1–18 years). All examinations were evaluated for the location of the injury and presence of fracture(s). Results: Finger injuries were dominant (n = 1346), with the fifth finger being the most frequently injured (n = 381). The majority of injuries were observed among children who were 11 years old (n = 176), with a visible peak in the 11- to 13-year-old group. A total of 625 bone fractures were detected. Fractures of the proximal phalanges (n = 213) and middle phalanges (n = 159) were most common, and fifth finger (n = 189) predominance was again observed. A gender-independent positive correlation was found between patients’ age and finger injuries (p < 0.01) as well as metacarpal injuries (p < 0.01). There was no correlation between patients’ age and fractures in these locations (p > 0.05). Metacarpal injuries (p < 0.01), finger injuries (p < 0.01), fractures (p = 0.01), and fractures with displacement (p = 0.03) were more common among males regardless of age. Conclusions: The results indicate that 11-year-old boys are at an increased risk of hand injuries and fractures. The distal and middle phalanges of the right hand, especially of the fifth digit, were the most susceptible to fracture localisation. Thus, injuries in these areas should be perceived as most likely to cause fractures and therefore demand careful examination.

Distribution and pattern of hand fractures in children and adolescents

“…Pediatric hand fractures were regularly distributed during a 1-year period without significant differences between the different seasons, which is according to the recent literature [12,13]. No significant differences in the month of occurrence were observed for hand fractures based on location or allocated for different age groups in a retrospective cross sectional study of 1441 post-traumatic hand radiopgraphs [12]. This was also seen in a prospective survey of 161 hand fractures with a mean patients' age of 24 (range 2-76) [13].…”

Epidemiology and Fracture Patterns of Traumatic Phalangeal Fractures

“…The literature fails to reach a consensus on which phalanx is most susceptible to fracture in adult populations, although our findings are most consistent with those of Weum et al [7][8][9] The high frequency of blunt trauma injuries in the current population may explain the high fracture rate in the proximal phalanx, considering that a relationship between blunt trauma injuries and proximal phalanx injuries has been established in pediatric literature. 18,20,21 Thus, these findings highlight the need to carefully examine the proximal phalanx for fractures in the setting of blunt trauma injuries, and future efforts may be directed at designing safety equipment that more specifically protects the proximal phalanges from blunt trauma.…”

“…This is consistent with findings in a pediatric population and one prior publication in an adult population. 7,18 However, a general consensus on the digit most susceptible to fracture is lacking in adult populations. Brown 19 found the middle finger to be the most common and suggested that the frequency of fractures is proportional to the length of the digit.…”

“…A trend that was reported before in a pediatric population may explain this pattern. Cebula et al 18 noted that younger patients (0‐8 years old) often sustain distal phalangeal fractures due to crush mechanisms (eg, finger jammed in door), and older patients (9‐16 years of age) sustain proximal phalangeal fractures secondary to sports and fights, highlighting how the mechanism of injury can change the fracture profile. In this adult population, blunt trauma (eg, falls and sports) and crush are the most common mechanisms of injury.…”

The Competency of Emergency Medicine Residents in Interpreting Hand X-rays Across the Three Major Regions of Saudi Arabia

“…EM residents must possess a comprehensive understanding of normal hand anatomy, including bones, joints, soft tissues, and vasculature, to accurately identify abnormalities and pathology on radiological images [ 5 , 6 ]. Additionally, familiarity with common injury patterns, mechanisms of injury, and clinical presentations is crucial for making accurate diagnoses and providing appropriate management strategies [ 1 , 4 , 7 ].…”