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The Effect of Family Socioeconomic Status on the Outcomes of Titanium Elastic Nailing in Pediatric Both-Bone Forearm Fractures

Yıl 2026, Cilt: 9 Sayı: 1, 19 - 23, 17.03.2026
https://izlik.org/JA38GC24PH

Öz

Aim: This study aimed to evaluate the effects of parental socioeconomic status, including education and occupation levels, on bone healing and functional recovery in pediatric both-bone forearm fractures treated with titanium elastic nailing.
Methods: A retrospective analysis was conducted on 84 pediatric patients (55 males, 29 females; mean age 9.7 ± 2.2 years) who underwent titanium elastic nailing fixation for both-bone forearm fractures between November 2022 and August 2024. Patients with open, pathological, or multiple fractures were excluded. Socioeconomic status was determined using a modified Hollingshead Index based on parental education and occupation. Clinical outcomes were assessed using Price criteria and goniometric measurements of elbow and wrist range of motion. Statistical analyses included the Mann–Whitney U, Kruskal–Wallis, and Spearman correlation tests.
Results: All fractures achieved union, and no major complications such as nonunion or refracture were observed. Seven patients (8.3%) developed minor superficial wound infections, which resolved with conservative treatment. According to Price criteria, 52.4% of patients had excellent, 39.3% good, and 8.3% fair results. Higher socioeconomic levels were significantly correlated with better Price scores (p = 0.001) and decreased elbow extension loss (p = 0.007). There was no significant correlation between socioeconomic status and wrist flexion/ extension, elbow flexion range of motion.
Conclusion: Higher parental socioeconomic status was associated with improved functional recovery, particularly in forearm rotation and elbow extension, following titanium elastic nailing fixation of pediatric forearm fractures. Emphasizing the importance of postoperative rehabilitation among families with lower socioeconomic levels may help prevent residual joint limitations.

Kaynakça

  • 1. Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. Aug 2007;38(8):913-22. doi:10.1016/j.injury.2007.01.036
  • 2. Ulgen NK, Nazligul AS, Yigit N, Erginoglu SE, Akkurt MO. Epidemiologic Patterns of Musculoskeletal Disorders by Body Region Across 1.2 Million Orthopedic Visits: A 15-Year Experience From a Middle-Income Country. J Eval Clin Pract. Aug 2025;31(5):e70230. doi:10.1111/jep.70230
  • 3. Patel A, Li L, Anand A. Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both-bone diaphyseal forearm fractures in children. Injury. Aug 2014;45(8):1135-43. doi:10.1016/j.injury.2014.04.020
  • 4. Chia B, Kozin SH, Herman MJ, Safier S, Abzug JM. Complications of pediatric distal radius and forearm fractures. Instr Course Lect. 2015;64:499-507.
  • 5. Joeris A, Lutz N, Wicki B, Slongo T, Audige L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr. Dec 20 2014;14:314. doi:10.1186/s12887-014-0314-3
  • 6. Caruso G, Caldari E, Sturla FD, et al. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg. Dec 2021;105(3):225-234. doi:10.1007/s12306-020-00684-6
  • 7. Truntzer J, Vopat ML, Kane PM, Christino MA, Katarincic J, Vopat BG. Forearm diaphyseal fractures in the adolescent population: treatment and management. Eur J Orthop Surg Traumatol. Feb 2015;25(2):201-9. doi:10.1007/s00590-014-1489-x
  • 8. Wall L, O'Donnell JC, Schoenecker PL, et al. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop B. Sep 2012;21(5):482-8. doi:10.1097/BPB.0b013e3283528db5
  • 9. Modest JM, Brodeur PG, Kim KW, Testa EJ, Gil JA, Cruz AI, Jr. Social Disparities in Outpatient and Inpatient Management of Pediatric Supracondylar Humerus Fractures. J Clin Med. Aug 5 2022;11(15)doi:10.3390/jcm11154573
  • 10. Fletcher ND, Sirmon BJ, Mansour AS, Carpenter WE, Ward LA. Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures. J Child Orthop. Oct 2016;10(5):421-7. doi:10.1007/s11832-016-0769-x
  • 11. Farrell C, Hannon M, Monuteaux MC, Mannix R, Lee LK. Pediatric Fracture Epidemiology and US Emergency Department Resource Utilization. Pediatr Emerg Care. Jul 1 2022;38(7):e1342-e1347. doi:10.1097/PEC.0000000000002752
  • 12. Shenoy DA, Shabana S, Hunter E, et al. The impact of individual and regional socioeconomic identity on pediatric extremity fracture management: A scoping review. Injury. Oct 2025;56(10):112674. doi:10.1016/j.injury.2025.112674
  • 13. Goyal MK, Johnson TJ, Chamberlain JM, et al. Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics. May 2020;145(5)doi:10.1542/peds.2019-3370
  • 14. Gultekin MZ, Dogar F, Sari AS, Coskun F, Yildirim A. The role of the psychological attributes of parents and children, and fracture history in upper extremity fractures in school-age and adolescents: A case-control study. Jt Dis Relat Surg. Mar 21 2024;35(2):315-323. doi:10.52312/jdrs.2023.1486
  • 15. Montgomery BK, Joseph G, Segovia N, et al. The Influence of Race, Income, and Sex on Treatment and Complications of Common Pediatric Orthopedic Fractures. Orthopedics. May 2023;46(3):e156-e160. doi:10.3928/01477447-20230104-06
  • 16. Li NY, Bruce WJ, Joyce C, Decker NM, Cappello T. Obesity's Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop. Mar 2018;38(3):e118-e121. doi:10.1097/BPO.0000000000001126
  • 17. Chua WJ, Klein EJ, Al-Haddad BJS, Quan L. Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department. Pediatr Emerg Care. Dec 1 2021;37(12):e1093-e1097. doi:10.1097/PEC.0000000000001908
  • 18. Warwick D. Injuries of the forearm and wrist Apley’ system of orthopaedics and fractures. 9th edn. ed. 768-776:chap 25.
  • 19. Ersoy B, Hanedan N, Ozyurt B. Socioeconomic Status and Age at Menarche in Turkiye. Am J Hum Biol. Jan 2025;37(1):e24181. doi:10.1002/ajhb.24181
  • 20. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop. Nov-Dec 1990;10(6):705-12. doi:10.1097/01241398-199011000-00001
  • 21. Pace JL. Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations. J Am Acad Orthop Surg. Nov 2016;24(11):780-788. doi:10.5435/JAAOS-D-15-00151
  • 22. Lee AK, Beck JD, Mirenda WM, Klena JC. Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures. J Pediatr Orthop. Dec 2016;36(8):810-815. doi:10.1097/BPO.0000000000000568
  • 23. Murphy HA, Jain VV, Parikh SN, Wall EJ, Cornwall R, Mehlman CT. Extensor Tendon Injury Associated With Dorsal Entry Flexible Nailing of Radial Shaft Fractures in Children: A Report of 5 New Cases and Review of the Literature. J Pediatr Orthop. Apr 2019;39(4):163-168. doi:10.1097/BPO.0000000000000897
  • 24. Han B, Wang Z, Li Y, Xu Y, Cai H. Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing. Int Orthop. Sep 2019;43(9):2093-2097. doi:10.1007/s00264-018-4184-4
  • 25. Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B. Sep 2016;25(5):439-46. doi:10.1097/BPB.0000000000000278
  • 26. Heath DM, Ghali AN, Momtaz DA, et al. Socioeconomic Status Affects Postoperative Time to Union in Pediatric Patients with a Surgically Treated Fracture. JB JS Open Access. Jul-Sep 2023;8(3)doi:10.2106/JBJS.OA.22.00137
  • 27. Cassedy A, Drotar D, Ittenbach R, et al. The impact of socio-economic status on health related quality of life for children and adolescents with heart disease. Health Qual Life Outcomes. Jun 18 2013;11:99. doi:10.1186/1477-7525-11-99
  • 28. Limbers CA, Ripperger-Suhler J, Boutton K, Ransom D, Varni JW. A comparative analysis of health-related quality of life and family impact between children with ADHD treated in a general pediatric clinic and a psychiatric clinic utilizing the PedsQL. J Atten Disord. Jul 2011;15(5):392-402. doi:10.1177/1087054709356191
  • 29. Ozguven I, Ersoy B, Ozguven AA, Erbay PD. Evaluation of nutritional status in Turkish adolescents as related to gender and socioeconomic status. J Clin Res Pediatr Endocrinol. 2010;2(3):111-6. doi:10.4274/jcrpe.v2i3.111
  • 30. Marino BS, Tomlinson RS, Wernovsky G, et al. Validation of the pediatric cardiac quality of life inventory. Pediatrics. Sep 2010;126(3):498-508. doi:10.1542/peds.2009-2973
  • 31. Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol. 2002;53:371-99. doi:10.1146/annurev.psych.53.100901.135233
  • 32. Poulain T, Vogel M, Kiess W. Review on the role of socioeconomic status in child health and development. Curr Opin Pediatr. Apr 2020;32(2):308-314. doi:10.1097/MOP.0000000000000876
  • 33. Landau AJ, Oladeji AK, Hosseinzadeh P. Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States. J Am Acad Orthop Surg Glob Res Rev. Jul 1 2022;6(7)doi:10.5435/JAAOSGlobal-D-22-00126
  • 34. Vazquez S, Dominguez JF, Jacoby M, et al. Poor socioeconomic status is associated with delayed femoral fracture fixation in adolescent patients. Injury. Dec 2023;54(12):111128. doi:10.1016/j.injury.2023.111128

Ailenin Sosyoekonomik Düzeyinin Pediatrik Önkol Kırıklarında Titanyum Elastik Çivileme Sonuçlarına Etkisi

Yıl 2026, Cilt: 9 Sayı: 1, 19 - 23, 17.03.2026
https://izlik.org/JA38GC24PH

Öz

Amaç: Bu çalışma, her iki ön kol kemiği kırığı nedeniyle titanyum elastik çivileme uygulanan pediatrik hastalarda ebeveynlerin sosyoekonomik durumunun, özellikle eğitim ve meslek düzeylerinin kemik kaynaması ve fonksiyonel iyileşme üzerindeki etkilerini değerlendirmeyi amaçladı.
Yöntem: Kasım 2022 ile Ağustos 2024 tarihleri arasında her iki ön kol kemiği kırığı nedeniyle titanyum elastik çivi ile tespit edilen 84 pediatrik hasta (55 erkek, 29 kız; ortalama yaş 9,7 ± 2,2 yıl) retrospektif olarak incelendi. Açık, patolojik veya çoklu kırığı olan hastalar çalışma dışı bırakıldı. Sosyoekonomik durum, ebeveynlerin eğitim ve meslek düzeylerini temel alan modifiye Hollingshead İndeksi ile belirlendi. Klinik sonuçlar Price kriterleri, dirsek ile el bileği eklemlerinin gonyometri ile ölçülen hareket açıklığı ölçümleri kullanılarak değerlendirildi. İstatistiksel analizlerde Mann–Whitney U, Kruskal–Wallis ve Spearman korelasyon testleri uygulandı.
Bulgular: Tüm olgularda kırık kaynaması sağlandı. Kaynamama veya tekrar kırık gibi majör komplikasyonlar gözlenmedi. Yedi hastada (%8,3) gelişen yüzeyel yara enfeksiyonları konservatif tedavi ile tamamen düzeldi. Price kriterlerine göre hastaların %52,4’ü mükemmel, %39,3’ü iyi ve %8,3’ü orta sonuçlara sahipti. Daha yüksek sosyoekonomik düzey, anlamlı olarak daha iyi Price skorları (p = 0,001) ve daha az dirsek ekstansiyon kaybı (p = 0,007) ile ilişkiliydi. Sosyoekonomik durum ile el bileği fleksiyon/ekstansiyonu veya dirsek fleksiyon hareket açıklığı arasında anlamlı bir ilişki saptanmadı.
Sonuç: Daha yüksek ebeveyn sosyoekonomik düzeyi, titanyum elastik çivi ile tedavi edilen pediatrik ön kol kırıklarında fonksiyonel iyileşmenin, özellikle ön kol rotasyonu ve dirsek ekstansiyonu açısından daha iyi olmasına katkı sağlamaktadır. Düşük sosyoekonomik düzeye sahip ailelerde postoperatif rehabilitasyonun öneminin vurgulanması, eklem hareket kısıtlılıklarının önlenmesine yardımcı olabilir.

Kaynakça

  • 1. Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. Aug 2007;38(8):913-22. doi:10.1016/j.injury.2007.01.036
  • 2. Ulgen NK, Nazligul AS, Yigit N, Erginoglu SE, Akkurt MO. Epidemiologic Patterns of Musculoskeletal Disorders by Body Region Across 1.2 Million Orthopedic Visits: A 15-Year Experience From a Middle-Income Country. J Eval Clin Pract. Aug 2025;31(5):e70230. doi:10.1111/jep.70230
  • 3. Patel A, Li L, Anand A. Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both-bone diaphyseal forearm fractures in children. Injury. Aug 2014;45(8):1135-43. doi:10.1016/j.injury.2014.04.020
  • 4. Chia B, Kozin SH, Herman MJ, Safier S, Abzug JM. Complications of pediatric distal radius and forearm fractures. Instr Course Lect. 2015;64:499-507.
  • 5. Joeris A, Lutz N, Wicki B, Slongo T, Audige L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr. Dec 20 2014;14:314. doi:10.1186/s12887-014-0314-3
  • 6. Caruso G, Caldari E, Sturla FD, et al. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg. Dec 2021;105(3):225-234. doi:10.1007/s12306-020-00684-6
  • 7. Truntzer J, Vopat ML, Kane PM, Christino MA, Katarincic J, Vopat BG. Forearm diaphyseal fractures in the adolescent population: treatment and management. Eur J Orthop Surg Traumatol. Feb 2015;25(2):201-9. doi:10.1007/s00590-014-1489-x
  • 8. Wall L, O'Donnell JC, Schoenecker PL, et al. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop B. Sep 2012;21(5):482-8. doi:10.1097/BPB.0b013e3283528db5
  • 9. Modest JM, Brodeur PG, Kim KW, Testa EJ, Gil JA, Cruz AI, Jr. Social Disparities in Outpatient and Inpatient Management of Pediatric Supracondylar Humerus Fractures. J Clin Med. Aug 5 2022;11(15)doi:10.3390/jcm11154573
  • 10. Fletcher ND, Sirmon BJ, Mansour AS, Carpenter WE, Ward LA. Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures. J Child Orthop. Oct 2016;10(5):421-7. doi:10.1007/s11832-016-0769-x
  • 11. Farrell C, Hannon M, Monuteaux MC, Mannix R, Lee LK. Pediatric Fracture Epidemiology and US Emergency Department Resource Utilization. Pediatr Emerg Care. Jul 1 2022;38(7):e1342-e1347. doi:10.1097/PEC.0000000000002752
  • 12. Shenoy DA, Shabana S, Hunter E, et al. The impact of individual and regional socioeconomic identity on pediatric extremity fracture management: A scoping review. Injury. Oct 2025;56(10):112674. doi:10.1016/j.injury.2025.112674
  • 13. Goyal MK, Johnson TJ, Chamberlain JM, et al. Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics. May 2020;145(5)doi:10.1542/peds.2019-3370
  • 14. Gultekin MZ, Dogar F, Sari AS, Coskun F, Yildirim A. The role of the psychological attributes of parents and children, and fracture history in upper extremity fractures in school-age and adolescents: A case-control study. Jt Dis Relat Surg. Mar 21 2024;35(2):315-323. doi:10.52312/jdrs.2023.1486
  • 15. Montgomery BK, Joseph G, Segovia N, et al. The Influence of Race, Income, and Sex on Treatment and Complications of Common Pediatric Orthopedic Fractures. Orthopedics. May 2023;46(3):e156-e160. doi:10.3928/01477447-20230104-06
  • 16. Li NY, Bruce WJ, Joyce C, Decker NM, Cappello T. Obesity's Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop. Mar 2018;38(3):e118-e121. doi:10.1097/BPO.0000000000001126
  • 17. Chua WJ, Klein EJ, Al-Haddad BJS, Quan L. Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department. Pediatr Emerg Care. Dec 1 2021;37(12):e1093-e1097. doi:10.1097/PEC.0000000000001908
  • 18. Warwick D. Injuries of the forearm and wrist Apley’ system of orthopaedics and fractures. 9th edn. ed. 768-776:chap 25.
  • 19. Ersoy B, Hanedan N, Ozyurt B. Socioeconomic Status and Age at Menarche in Turkiye. Am J Hum Biol. Jan 2025;37(1):e24181. doi:10.1002/ajhb.24181
  • 20. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop. Nov-Dec 1990;10(6):705-12. doi:10.1097/01241398-199011000-00001
  • 21. Pace JL. Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations. J Am Acad Orthop Surg. Nov 2016;24(11):780-788. doi:10.5435/JAAOS-D-15-00151
  • 22. Lee AK, Beck JD, Mirenda WM, Klena JC. Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures. J Pediatr Orthop. Dec 2016;36(8):810-815. doi:10.1097/BPO.0000000000000568
  • 23. Murphy HA, Jain VV, Parikh SN, Wall EJ, Cornwall R, Mehlman CT. Extensor Tendon Injury Associated With Dorsal Entry Flexible Nailing of Radial Shaft Fractures in Children: A Report of 5 New Cases and Review of the Literature. J Pediatr Orthop. Apr 2019;39(4):163-168. doi:10.1097/BPO.0000000000000897
  • 24. Han B, Wang Z, Li Y, Xu Y, Cai H. Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing. Int Orthop. Sep 2019;43(9):2093-2097. doi:10.1007/s00264-018-4184-4
  • 25. Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B. Sep 2016;25(5):439-46. doi:10.1097/BPB.0000000000000278
  • 26. Heath DM, Ghali AN, Momtaz DA, et al. Socioeconomic Status Affects Postoperative Time to Union in Pediatric Patients with a Surgically Treated Fracture. JB JS Open Access. Jul-Sep 2023;8(3)doi:10.2106/JBJS.OA.22.00137
  • 27. Cassedy A, Drotar D, Ittenbach R, et al. The impact of socio-economic status on health related quality of life for children and adolescents with heart disease. Health Qual Life Outcomes. Jun 18 2013;11:99. doi:10.1186/1477-7525-11-99
  • 28. Limbers CA, Ripperger-Suhler J, Boutton K, Ransom D, Varni JW. A comparative analysis of health-related quality of life and family impact between children with ADHD treated in a general pediatric clinic and a psychiatric clinic utilizing the PedsQL. J Atten Disord. Jul 2011;15(5):392-402. doi:10.1177/1087054709356191
  • 29. Ozguven I, Ersoy B, Ozguven AA, Erbay PD. Evaluation of nutritional status in Turkish adolescents as related to gender and socioeconomic status. J Clin Res Pediatr Endocrinol. 2010;2(3):111-6. doi:10.4274/jcrpe.v2i3.111
  • 30. Marino BS, Tomlinson RS, Wernovsky G, et al. Validation of the pediatric cardiac quality of life inventory. Pediatrics. Sep 2010;126(3):498-508. doi:10.1542/peds.2009-2973
  • 31. Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol. 2002;53:371-99. doi:10.1146/annurev.psych.53.100901.135233
  • 32. Poulain T, Vogel M, Kiess W. Review on the role of socioeconomic status in child health and development. Curr Opin Pediatr. Apr 2020;32(2):308-314. doi:10.1097/MOP.0000000000000876
  • 33. Landau AJ, Oladeji AK, Hosseinzadeh P. Assessment of Ethno-racial and Insurance-based Disparities in Pediatric Forearm and Tibial Fracture Care in the United States. J Am Acad Orthop Surg Glob Res Rev. Jul 1 2022;6(7)doi:10.5435/JAAOSGlobal-D-22-00126
  • 34. Vazquez S, Dominguez JF, Jacoby M, et al. Poor socioeconomic status is associated with delayed femoral fracture fixation in adolescent patients. Injury. Dec 2023;54(12):111128. doi:10.1016/j.injury.2023.111128
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Yasin Erdoğan 0000-0001-6862-9671

Hilmi Alkan 0000-0002-5451-4678

Gönderilme Tarihi 6 Ekim 2025
Kabul Tarihi 5 Şubat 2026
Yayımlanma Tarihi 17 Mart 2026
IZ https://izlik.org/JA38GC24PH
Yayımlandığı Sayı Yıl 2026 Cilt: 9 Sayı: 1

Kaynak Göster

APA Erdoğan, Y., & Alkan, H. (2026). The Effect of Family Socioeconomic Status on the Outcomes of Titanium Elastic Nailing in Pediatric Both-Bone Forearm Fractures. Journal of Cukurova Anesthesia and Surgical Sciences, 9(1), 19-23. https://izlik.org/JA38GC24PH
https://dergipark.org.tr/tr/download/journal-file/11303