Title: Post Fracture Activity Level Monitoring in Los Angeles Country Children & Adolescents

Author: Aura Elias, Gabrielle Noullet, Alexander Rueda, Anahit Malumyan, Mauricio Silva, Rachel Thompson

Area of Concentration (Petal): Research

Specialty (if any): Orthopaedic Surgery

Keywords: social determinates of health, orthopedic, fracture, return-to-activity

Background: Upper and lower extremity cast immobilization in children has been correlated with a significant reduction in physical activity. This reduction in high-intensity skeletal loading (vigorous) activity can lead to bone mineral loss. Socioeconomic and demographic disparities have also been shown to influence bone health. Racially and ethnically diverse children have disparities in fracture risk, access to orthopaedic care, and post-operative outcomes.

Objective: The objective of this article is to: 1) Determine if the rate of return-to-activity is slower in non-operatively treated lower extremity fractures compared to non-operative treated upper extremity fractures and 2) Investigate the correlation between demographic and socioeconomic factors to return-to-activity after an orthopaedic injury.

Methods: Eligible subjects, 6 – 14 years of age, were recruited after having an upper or lower extremity fracture that was treated with non-operative management. Social determinants of health were obtained through chart review and demographic surveys (Family Life Questionnaire and the PEARLS survey). Subjects were provided a StepWatch Activity Monitor (SAM) device and instructed to wear the device for four consecutive days (consisting of 2 school days and 2 weekend days) for a total of 6 weeks following the removal of their cast. Data collected through the SAM device and chart-reviewed data will be correlated to demographic and social factors.

Results: There are a total of 32 patients in the study. 13 are completed, 15 are ongoing, and 4 are excluded due to incomplete data. Of those completed, mean age is 11.07 ± 2.36 years. A total of 53.85% (7/13) of patients identify as Hispanic/Latino and 76.92% (10/13) of patients indicated that English is their primary language.

Conclusions: Limitations of the study have been related to patient adherence – low return rate on SAM devices and high rate of missing data. Further results and conclusions will be published once more data is collected and analyzed.