title: The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).
abstract: Background and purpose - The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) describes the localization and morphology of fractures, and considers severity in 2 categories: (1) simple, and (2) multifragmentary. We evaluated simple and multifragmentary fractures in a large consecutive cohort of children diagnosed with long bone fractures in Switzerland. Patients and methods - Children and adolescents treated for fractures between 2009 and 2011 at 2 tertiary pediatric surgery hospitals were retrospectively included. Fractures were classified according to the AO PCCF. Severity classes were described according to fracture location, patient age and sex, BMI, and cause of trauma. Results - Of all trauma events, 3% (84 of 2,730) were diagnosed with a multifragmentary fracture. This proportion was age-related: 2% of multifragmentary fractures occurred in school-children and 7% occurred in adolescents. In patients diagnosed with a single fracture only, the highest percentage of multifragmentation occurred in the femur (12%, 15 of 123). In fractured paired radius/ulna bones, multifragmentation occurred in 2% (11 of 687); in fractured paired tibia/fibula bones, it occurred in 21% (24 of 115), particularly in schoolchildren (5 of 18) and adolescents (16 of 40). In a multivariable regression model, age, cause of injury, and bone were found to be relevant prognostic factors of multifragmentation (odds ratio (OR) > 2). Interpretation - Overall, multifragmentation in long bone fractures in children was rare and was mostly observed in adolescents. The femur was mostly affected in single fractures and the lower leg was mostly affected in paired-bone fractures. The clinical relevance of multifragmentation regarding growth and long-term functional recovery remains to be determined.
authors.affiliation: a AO Clinical Investigation and Documentation , Dübendorf.|b Schulthess Clinic, Research and Development Upper Extremities , Zürich.
authors.forename: Laurent
authors.initials: L
authors.lastname: Audigé
authors.affiliation: c Department of Pediatric Surgery, Traumatology and Orthopedics , University Hospital (Inselspital) , Bern.
authors.forename: Theddy
authors.initials: T
authors.lastname: Slongo
authors.affiliation: d Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne , Switzerland.
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: a AO Clinical Investigation and Documentation , Dübendorf.
authors.forename: Alexander
authors.initials: A
authors.lastname: Joeris
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries; D005543:Forearm Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018460:Fractures, Comminuted / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011859:Radiography; D011885:Radius Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014458:Ulna Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology