title: The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).
abstract: Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the lower extremities of a representative population of children classified according to the PCCF. Patients and methods - We included patients up to the age of 17 who were diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at either of 2 tertiary care university hospitals in Switzerland. Patient charts were retrospectively reviewed. Results - More lower extremity fractures occurred in boys (62%, n = 341). Of 548 fractured long bones in the lower extremity, 25% involved the femur and 75% the lower leg. The older the patients, the more combined fractures of the tibia and fibula were sustained (adolescents: 50%, 61 of 123). Salter-Harris (SH) fracture patterns represented 66% of single epiphyseal fractures (83 of 126). Overall, 74 of the 83 SH patterns occurred in the distal epiphysis. Of all the metaphyseal fractures, 74 of 79 were classified as incomplete or complete. Complete oblique spiral fractures accounted for 57% of diaphyseal fractures (120 of 211). Of all fractures, 7% (40 of 548) were classified in the category "other", including 29 fractures that were identified as toddler's fractures. 5 combined lower leg fractures were reported in the proximal metaphysis, 40 in the diaphysis, 26 in the distal metaphysis, and 8 in the distal epiphysis. Interpretation - The PCCF allows classification of lower extremity fracture patterns in the clinical setting. Re-introduction of a specific code for toddler's fractures in the PCCF should be considered.
authors.affiliation: a AO Clinical Investigation and Documentation , Dübendorf.|b Department of Pediatric Surgery, Traumatology and Orthopedics , University Hospital (Inselspital) , Bern.
authors.forename: Alexander
authors.initials: A
authors.lastname: Joeris
authors.affiliation: c Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lutz
authors.affiliation: a AO Clinical Investigation and Documentation , Dübendorf.
authors.forename: Andrea
authors.initials: A
authors.lastname: Blumenthal
authors.affiliation: b Department of Pediatric Surgery, Traumatology and Orthopedics , University Hospital (Inselspital) , Bern.
authors.forename: Theddy
authors.initials: T
authors.lastname: Slongo
authors.affiliation: a AO Clinical Investigation and Documentation , Dübendorf.|d Research and Development Department , Schulthess Clinic , Zürich , Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Audigé
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007869:Leg Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D000072042:Salter-Harris Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017678:Sex Distribution; D013557:Switzerland / Q000453:epidemiology; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*