Injury-mechanism directness as a key factor for fracture laterality in pediatric extremity fractures

The associations between certain extremity fracture sites and laterality in pediatric trauma are well known [1], and specific body parts in the left or non-dominant arm [[2], [3], [4]] and the right or dominant leg [5] are more vulnerable to fractures. However, the reason for this laterality tendency is unclear. Furthermore, the influence of hand and foot dominance on the incidence of various types of fractures in pediatric trauma has scarcely been studied.

Upon losing their balance, children without neurological or vestibular dysfunction normally undertake balance-restoring actions [6,7]. However, the competence of this protective motion depends on many factors, which emphasizes the importance of determining whether such action is performed by a dominant extremity [8]. We have observed that many pediatric limb fractures seem to occur in loss-of-balance (LOB) situations, most of which are unaccompanied by a loss of consciousness (LOC) or vestibular functional deficits. Therefore, limb dominance may be involved in the determination of fracture laterality when an injury occurs in a LOB situation via the balance-restoring action. Moreover, the influence of limb dominance will be greater in an indirect injury (wherein there is no direct blow to the fracture site) than in a direct injury.

Pursuant to these concerns, we hypothesized that the laterality tendency of a specific fracture would be affected by the directness of the injury mechanism and not by the fracture site itself. Among children without neurological or vestibular dysfunction who were injured in LOB situations, we investigated the laterality tendencies of various pediatric fractures with regard to the directness of the injury mechanism and the specific fracture site. Additionally, some specific types of fractures are associated with certain injury mechanisms [[9], [10], [11], [12]]; therefore, we thoroughly analyzed injury mechanisms among fractures with laterality proneness.

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