Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

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

PDF Cite this article

Muhammet Zeki Gültekin

Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye

ORCID: 0000-0003-2160-8237

Fatih Doğar

Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye

ORCID: 0000-0003-3848-1017

Ahmet Sinan Sarı

Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye

ORCID: 0000-0002-5429-1929

Fatma Coşkun

Department of Child and Adolescent Psychiatry, Konya Necmettin Erbakan University, Meram Medical Faculty, Konya, Türkiye

ORCID: 0000-0001-6917-2327

Ahmet Yıldırım

Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye

ORCID: 0000-0002-3953-091X

Abstract

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.

Declarations

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.

Informed Consent

Written informed consent was obtained from all participating parents who agreed to participate in the study.

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.

References

  1. Jones IE, Williams SM, Dow N, Goulding A. How many children remain fracture-free during growth? A longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study. Osteoporos Int 2002;13:990-5. DOI: 10.1007/s001980200137.
  2. Lee J, Choi YJ, Seo BF, Jung SN, Choi JY. Dupuytren contracture after acute traumatic hand injury in an adolescent: A case report. Jt Dis Relat Surg 2023;34:737-40. DOI: 10.52312/jdrs.2023.1168.
  3. Nakaniida A, Sakuraba K, Hurwitz EL. Pediatric orthopaedic injuries requiring hospitalization: Epidemiology and economics. J Orthop Trauma 2014;28:167-72. DOI: 10.1097/BOT.0b013e318299cd20.
  4. Ma D, Jones G. Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: A population-based case control study. J Bone Miner Res 2003;18:1970-7. DOI: 10.1359/jbmr.2003.18.11.1970.
  5. Keyes KM, Susser E, Pilowsky DJ, Hamilton A, Bitfoi A, Goelitz D, et al. The health consequences of child mental health problems and parenting styles: Unintentional injuries among European schoolchildren. Prev Med 2014;67:182-8. DOI: 10.1016/j.ypmed.2014.07.030.
  6. Spinks AB, Nagle C, Macpherson AK, Bain C, McClure RJ. Host factors and childhood injury: The influence of hyperactivity and aggression. J Dev Behav Pediatr 2008;29:117-23. DOI: 10.1097/DBP.0b013e318163c3b0.
  7. Schwebel DC, Roth DL, Elliott MN, Windle M, Grunbaum JA, Low B, et al. The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders. Accid Anal Prev 2011;43:848-52. DOI: 10.1016/j.aap.2010.11.004.
  8. Schwebel DC, Brezausek CM. Chronic maternal depression and children's injury risk. J Pediatr Psychol 2008;33:1108-16. DOI: 10.1093/jpepsy/jsn046.
  9. Hollingshead AB, Redlich FC. Social class and mental illness: A community study. 1958. Am J Public Health 2007;97:1756-7. DOI: 10.2105/ajph.97.10.1756.
  10. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychol Med 2005;35:245-56. DOI: 10.1017/s0033291704002892.
  11. Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord 2001;31:5-17. DOI: 10.1023/a:1005653411471.
  12. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. J Abnorm Child Psychol 1998;26:257-68. DOI: 10.1023/a:1022602400621.
  13. Gianarris WJ, Golden CJ, Greene L. The Conners' Parent Rating Scales: A critical review of the literature. Clin Psychol Rev 2001;21:1061-93. DOI: 10.1016/s0272-7358(00)00085-4.
  14. Wilson BN, Crawford SG, Green D, Roberts G, Aylott A, Kaplan BJ. Psychometric properties of the revised Developmental Coordination Disorder Questionnaire. Phys Occup Ther Pediatr 2009;29:182-202. DOI: 10.1080/01942630902784761.
  15. Atik OŞ. Writing for Joint Diseases and Related Surgery (JDRS): There is something new and interesting in this article! Jt Dis Relat Surg 2023;34:533. DOI: 10.52312/jdrs.2023.57916.
  16. Wang H, Yu H, Zhou Y, Li C, Liu J, Ou L, et al. Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study. Medicine (Baltimore) 2017;96:e7879. DOI: 10.1097/MD.0000000000007879.
  17. Ziv-Baran T, Zacay G, Modan-Moses D, Reingold SM, Mekori E, Levy-Shraga Y. Increased fracture risk among children diagnosed with attention- deficit/hyperactivity disorder: A large matched cohort study. Eur J Pediatr 2023;182:2705-14. DOI: 10.1007/s00431-023-04929-x.
  18. Bancej C, Arbuckle T. Injuries in Ontario farm children: A population based study. Inj Prev 2000;6:135-40. DOI: 10.1136/ip.6.2.135.
  19. Alshahethi A, Al Serouri A, Khader YS. Rate and pattern of unintentional injuries among 9-12 grades schoolchildren in Yemen and their associated factors. J Inj Violence Res 2018;10:75-82. DOI: 10.5249/jivr.v10i2.966.
  20. Garzon DL. Contributing factors to preschool unintentional injury. J Pediatr Nurs 2005;20:441-7. DOI: 10.1016/j.pedn.2005.03.014.
  21. Acar E, Dursun OB, Esin İS, Öğütlü H, Özcan H, Mutlu M. Unintentional injuries in preschool age children: Is there a correlation with parenting style and parental attention deficit and hyperactivity symptoms. Medicine (Baltimore) 2015;94:e1378. DOI: 10.1097/MD.0000000000001378.
  22. Xie Y, Gao X, Song Y, Zhu X, Chen M, Yang L, et al. Effectiveness of physical activity intervention on ADHD symptoms: A systematic review and meta-analysis. Front Psychiatry 2021;12:706625. DOI: 10.3389/fpsyt.2021.706625.
  23. Bradbury K, Janicke DM, Riley AW, Finney JW. Predictors of unintentional injuries to school-age children seen in pediatric primary care. J Pediatr Psychol 1999;24:423-33. DOI: 10.1093/jpepsy/24.5.423.
  24. Morrongiello BA, Walpole B, McArthur BA. Brief report: Young children's risk of unintentional injury: A comparison of mothers' and fathers' supervision beliefs and reported practices. J Pediatr Psychol 2009;34:1063-8. DOI: 10.1093/jpepsy/jsp011.
  25. Santagati G, Vezzosi L, Angelillo IF. Unintentional injuries in children up to six years of age and related parental knowledge, attitudes, and behaviors in Italy. J Pediatr 2016;177:267-72.e2. DOI: 10.1016/j.jpeds.2016.06.083.
  26. Coates EE, Tran Q, Le Y, Phares V. Parenting, coparenting, and adolescent adjustment in African American singlemother families: An actor-partner interdependence mediation model. J Fam Psychol 2019;33:649-60. DOI: 10.1037/fam0000552.
  27. Merrill RM, Lyon JL, Baker RK, Gren LH. Attention deficit hyperactivity disorder and increased risk of injury. Adv Med Sci 2009;54:20-6. DOI: 10.2478/v10039-009-0022-7.
  28. Lange H, Buse J, Bender S, Siegert J, Knopf H, Roessner V. Accident proneness in children and adolescents affected by ADHD and the impact of medication. J Atten Disord 2016;20:501-9. DOI: 10.1177/1087054713518237.
  29. Genç E, Genç HA, Bulut GC. Children with supracondylar humerus fractures have an increased risk of attention deficit hyperactivity disorder. Acta Orthop Belg 2021;87:159-66.