Background and Aims Fractures are one of the most common causes of emergency department visits in pediatric patients in the United States.¹ Timely treatment of these injuries is essential as a delay in management can lead to long term functional impairment, and additional operative procedures.² We sought to examine trends and identify factors that may be associated with operative management by utilizing a large national database.

Methods This study was approved by the institutional review board of the Hospital for Special surgery (IRB#2017–0169). Using Truven Health Marketscan 2015–2019, we identified patients under 21 years who were diagnosed with fracture at hand/wrist, foot/ankle, forearm, or lower leg level. The outcome was if patients received surgical treatments within 3 months of a fracture. A multivariable logistic regression model was created to identify risk factors for surgical treatment after fracture.

Results Among the 325,853 pediatric fracture cases we identified, 4.4% cases received surgical treatment within 3 months after first fracture diagnosis. Multivariate logistic regression showed that independent risk factors for surgical treatment after fracture diagnosis included older age, male gender, having 1 or more comorbidities, obesity, lower leg fracture, residence in North Central and South compared with Northeast, and lower household income. (Table 1)

Conclusions Our study demonstrates a number of demographic variables that are independently associated with the use of a surgical approach to repair pediatric fractures. The significance of a number of these findings could highlight the stark differences and disparities in fracture care for pediatric patients in the United States.