Published January 2019 | The Journal of Bone and Joint Surgery

When a toddler takes a tumble serious enough to fracture an elbow, chances are the toddler involved was female.

This was one of the key findings from a study led by Charles Mehlman, DO, MPH, director, Musculoskeletal Outcomes Research, that examined 17 years of medical records involving children under age 2 who were treated for supracondylar humeral fractures at Cincinnati Children’s. The study is the first of its kind to document treatment outcomes for this young patient cohort.

Supracondylar humeral fractures typically result from a fall onto an outstretched hand, which leads to a forced hyperextension of the elbow. When the researchers assembled the records of 103 patients who fit the study criteria, they were surprised to find that 69 cases involved females.

“It was not clear why a strong female preponderance of these fractures would occur in an age group for which one would expect the same risk of injury between sexes,” Mehlman says. “Possible explanations include lower relative bone density among young girls, and perhaps in combination with ligamentous laxity, which also has been shown to be greater among preschool girls.”

The study goes on to note that repairing these elbow fractures in such young children can be technically challenging. Of the 46 children diagnosed with bicolumnar fixation five (11%) demonstrated “loss of reduction,” or failure to fully close the fracture. However, among 55 patients with fixation of only the lateral column, 20 (36%) demonstrated loss of reduction.

“We discovered rates of loss of reduction at the time of healing that we found concerning,” Mehlman says. “Clinical experience has shown that surgical care of these infantile patients is technically challenging. Post-surgical casting also can be imperfect. These results suggest that every effort should be made to utilize form-fitting postoperative immobilization.”