Psychiatric risk factors in pediatric hand fractures.

BACKGROUND: Various psychopathologies are becoming more commonly recognized as a cause of violence in the pediatric population. In this study, we aimed to investigate (1) the link between the pediatric hand fractures and psychopathology and (2) the prevalence of repeated hand injuries in the same population.

METHOD: We retrospectively reviewed 208 patients treated at a level 1 trauma center and recorded age, sex, past medical and psychiatric history as well as type, etiology, and treatment of hand fractures for analysis. A mental health professional has confirmed psychiatric diagnosis. Fisher exact tests and independent samples t tests were performed for analysis.

RESULTS: Metacarpal fractures were the most common hand fracture seen in patients with a psychiatric history (P=0.05). More than half (52.9%, n=18) of the patients with a positive psychiatric history had a subsequent injury whereas only 14.6% (n=29) of patients negative for psychiatric issues had a subsequent injury (P<0.001). The most common psychiatric disorders were attention-deficit hyperactivity disorder, depression, and substance abuse. Psychiatric diagnosis was significantly more frequent in those sustaining an injury due to punching compared with other mechanisms (38% vs. 8%, P<0.001). Twenty one (38%) of the 55 children whose injuries were due to punching had a documented psychiatric diagnosis. Of the 55 injuries due to a punching mechanism, 39 (68.4%) sustained metacarpal fractures and 18 (31.6%) sustained another type of hand fracture (P<0.001).

CONCLUSIONS: The high rate of repeated hand injuries in children with punching may require in depth psychiatric assessment due to its high association with mental illness.

LEVEL OF EVIDENCE: IV.