Pediatric Long Bone Fractures After Dog Bites: A Case Series and Systematic Review

Abstract

This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies on "pediatric fracture dog bite" based on a search of PubMed and OVID Medline databases was performed by adhering to PRISMA guidelines. Articles in English describing pediatric long bone fractures due to dog bites were included. Studies not differentiating pediatric from adult patients and not describing long bone fractures due to dog bites were excluded. Study characteristics, fracture epidemiology, management decisions, and follow-up data were extracted. Additionally, a seven-year retrospective chart review of cases treated at our level one pediatric trauma center was performed. Data on fracture characteristics, surgical management, choice of antibiotic therapy, and follow-up were collected. Five studies that met our criteria were analyzed. Pediatric long bone fractures from dog bites were identified in 0.35% (11/3,156) of patients. Such fractures most commonly involved the upper extremity (9/11, 82%). None of the studies described the choice of antibiotics, surgical decision-making, or wound closure preference for an underlying fracture. Our chart review elicited three cases of long bone fractures due to dog bites. Pediatric long bone fractures after dog bites are a rare injury pattern in the United States. These injuries should be treated as contaminated open fractures, and urgent immunization, intravenous antibiotic administration, wound care, and fracture stabilization should be provided. We recommend meticulous surgical debridement in the operating room, as wounds often probe deep into the bone. Nevertheless, there is much that remains unclear about these injuries. Hence, further research with greater power is needed to improve treatment decisions.

Keywords: animal bite; dog bite; open fracture; pediatric; wound closure.

Figure 1. Clinical image of puncture wounds of the dorsal distal forearm due to a dog bite

Figure 2. Anteroposterior (AP) and lateral X-ray imaging

The arrows point to a displaced distal ulna fracture with an overlying splint

Figure 3. Clinical image of a dorsal distal forearm laceration with exposed subcutaneous tissue

Figure 4. AP and lateral X-ray imaging of the left wrist

The arrows point to dorsally angulated, extra-articular distal radius, and ulna fractures

Figure 5. Clinical image of the anteromedial right leg and foot with dog bite wounds

Figure 6. Clinical image of the anterolateral right leg and foot with dog bite wounds

Figure 7. Clinical image of the plantar foot and posteromedial leg with dog bite wounds

Figure 8. AP view X-ray imaging of the right leg

The arrows point to the distal tibial shaft and distal fibula fractures

Figure 9. Clinical image showing intraoperative exploration of the dorsal foot wound demonstrating violation of the extensor tendons

Figure 10. Clinical image of intraoperative probing of the right leg wound with a Freer elevator

Figure 11. Corresponding intraoperative fluoroscopic imaging

The arrows show fracture continuity with the wound via probing

Figure 12. PRISMA flow diagram depicting the selection of studies

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis