Muhammet Zeki Gültekin1, Fatih Doğar1, Ahmet Sinan Sarı1, Fatma Coşkun2, Ahmet Yıldırım1

1Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye
2Department of Child and Adolescent Psychiatry, Konya Necmettin Erbakan University, Meram Medical Faculty, Konya, Türkiye

Keywords: Bone fractures, children, psychological factors, risk factors, school-age population, upper extremity.


Objectives: This study aims to investigate the influence of parents and children's psychological attributes and previous fracture history on upper extremity fractures in school-aged and adolescent children.

Patients and methods: Between January 2022 and January 2023, a total of 194 participants consisting of 97 cases with upper extremity fractures (23 males, 74 females; median age: 10 years; range, 6 to 16 years) and 97 age-matched controls suffering from growing pains (47 males, 50 females; median age: 10 years; range, 6 to 16 years) were included in this case-control study. Both cases and controls were of school-age or over. The parents of the children were interviewed face-to-face using psychological scales including the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), the Autism-Spectrum Quotient (AQ), the Short Form of the Conners’ Parent Rating Scale-Revised (CPRS-R:S), and the Developmental Coordination Disorder Questionnaire 2007 (DCDQ’07). The results derived from these scales and the demographics of the participants were evaluated in terms of their association with the risk of upper extremity fractures.

Results: A household income below the official minimum monthly wage (MMW) and a previous fracture history showed a higher risk for upper extremity fractures (odds ratio [OR]=2.38, 95% confidence interval [CI]: 1.07-5.26 and OR=24.93, 95% CI: 3.27-189.98, respectively). In the univariate analyses, elevated scores on the hyperactivity subscale of CPRS-R:S (CPRS-R:SHS) were associated with a higher fracture risk (OR=1.14, 95% CI: 1.05-1.24). Furthermore, both a household income below MMW, a previous fracture history, and higher CPRS-R:S-HS scores were found as independent risk factors for upper extremity fractures in the multivariate regression analysis (OR=2.78, 95% CI: 1.13-6.86, OR=21.79, 95% CI: 2.73-174.03), and OR=1.11, 95% CI: 1.02-1.22, respectively).

Conclusion: Our study results highlight the importance of known risk factors for upper extremity fractures such as lower monthly wage and the presence of previous fractures. The psychological states of parents and children should be evaluated together.

Citation: Gültekin MZ, Doğar F, Sarı AS, Coşkun F, Yıldırım 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 2024;35(2):315-323. doi: 10.52312/jdrs.2023.1486.

Ethics Committee Approval

The study protocol was approved by the Necmettin Erbakan University NonPharmaceutical and Medical Device Research Ethics Committee (date: 07.10.2022, no: 2022/3998). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Concept, design: M.Z.G., F.Ç; Supervision: F.D., A.S.S., A.Y.; Data collection: M.Z.G., F.D., A.S.S.; Data analysis, literature review, writing: M.Z.G., F.D., A.S.S., F.Ç.; Critical review: A.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.