Burden,aetiology,and characteristics of physeal injuries in children with long bone fractures seen at Mulago National Referral Hospital.

Abstract

Introduction Physeal fractures are quite common in pediatric trauma and account for about 25% of all pediatric long-bone fractures worldwide. Injury-induced physeal growth arrest can result in limb length discrepancy and deformities with secondary significant long-term disability. There is a growing body of evidence about the increasing burden of these injuries in Uganda over the past two decades hence the need for injury characterization and prevention. Objective To determine the prevalence, etiology, and characteristics of physeal injuries in children with long bone fractures seen at MNRH. Methodology A cross-sectional study was conducted at the Accident and Emergency Unit (A&E) and Surgical Outpatient Department (SOPD) of Mulago National Hospital over 4 months. Children suspected of musculoskeletal injuries underwent standard radiographs. Those diagnosed with long bone fractures were enrolled after obtaining informed consent. An interviewer-administered questionnaire captured etiological mechanisms, injury patterns, and associated factors. Selected Anthropometric measurements were taken and venous blood was collected for bone profile analysis. Data was coded, entered into EPI DATA 3.1, and analyzed using STATA 15. The prevalence of physeal injuries was calculated, causes and patterns described, and factors with P-values <0.05 in multivariate analysis were considered statistically significant. Results The prevalence of physeal injury in children with long bone fractures was found to be 18.9%. Falls were the predominant etiological mechanism contributing to 79.1% of the cases followed by sports and RTAs at 9.3% and 7.0% respectively. There was significant involvement of the distal humerus physis in 60.5% of the cases, and SH-II was the predominant pattern in 43.2% of these injuries. Vitamin D deficiency/insufficiency (Adj.PR = 2.88,95%CI=1.63-5.08) and injuries occurring in educational facilities (Adj.PR = 2.49, 95%CI =1.44-4.32) were the only two factors significantly associated with physeal injuries.Conclusion Physeal injury burden still remains high and the majority in our setting are mainly caused by falls, RTAs and sports. Vitamin D deficiency /insufficiency and fractures occurring in educational facility are the only factors predictive of physeal injuries.