Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7053-7061
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7053
Fracture risk assessment in children with benign bone lesions of long bones
Hai-Bing Li, Wen-Song Ye, Qiang Shu
Hai-Bing Li, Wen-Song Ye, Department of Paediatric Orthopaedics, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
Qiang Shu, Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
Author contributions: Li HB carried out the majority of the study, analyzed data, and prepared the manuscript; Ye WS supervised the study and wrote most of the manuscript; Shu Q provided suggestions for the study and critically reviewed the manuscript; all authors read and approved the final manuscript.
Supported by Natural Science Foundation of Zhejiang Province, No. LY20H060001.
Institutional review board statement: The study was reviewed and approved by the Children's Hospital of Zhejiang University Institutional Review Board, No. 2020-IRB-052.
Informed consent statement: A written consent was obtained from all participants prior to this study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Shu, PhD, Chief Doctor, Department of Pediatric Surgery, The Children’s Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou 310052, Zhejiang Province, China. shuqiang@zju.edu.cn
Received: April 22, 2021
Peer-review started: April 22, 2021
First decision: May 24, 2021
Revised: May 29, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: August 26, 2021
Abstract
BACKGROUND

Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated.

AIM

To investigate the risk factors for pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risk.

METHODS

We retrospectively reviewed 96 pediatric patients with benign bone lesions. We compared radiographic and clinical features between 40 patients who had fractures through a benign bone lesion and 56 who had no fracture. Information including histological diagnosis, anatomical site, radiographic appearance, severity of pain, and lesion size was recorded for the patients. A modified scoring system was proposed to predict the risk of fracture.

RESULTS

The univariate comparisons showed a significant difference between the fracture and non-fracture groups in terms of lesion type, pain, lesion-to-bone width, and axial cortical involvement of the patients (P < 0.05). Lesion type, pain, lesion-to-bone width, and axial cortical involvement were independently correlated with an increased risk of fracture. The mean score of the fracture group was 7.89, whereas the mean score of the non-fracture group was 6.01. The optimum cut-off value of the score to predict pathological fracture was 7. The scoring system had a sensitivity of 70% and a specificity of 80% for detecting patients with fractures. The Youden index was 0.5, which was the maximum value. The area under the receiver operator characteristic was 0.814.

CONCLUSION

Lesion type, pain, lesion-to-bone width, and axial cortical involvement are risk factors for pathological fracture. The modified scoring system can provide evidence for clinical decision-making in children with benign bone lesions. A bone lesion with a total score > 7 indicates a high risk of a pathologic fracture and is an indication for prophylactic internal fixation.

Keywords: Benign bone lesion, Pathological fracture, Risk factor, Children

Core Tip: The purpose of this study was to investigate the risk factors of pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risks. As a fracture predictive tool, the modified scoring system can be used to evaluate before treatment and provide reference for surgical decision-making.