Irreducible extremity fractures in pediatric and adolescent rodeo-related trauma: A retrospective case series

Purpose: Although most pediatric extremity fractures can be managed with closed reduction, even when operative fixation is required, youth rodeo exposes participants to high-energy livestock-related trauma that may produce fracture patterns associated with failed closed reduction. This study described operative management and fracture irreducibility in pediatric and adolescent extremity injuries sustained during organized rodeo participation. Methods: A retrospective case series was performed at a Level I pediatric trauma center. Patients aged ≤18 years who sustained injuries during organized rodeo participation between November 2017 and December 2023 were identified through trauma registry review. Demographics, injury characteristics, operative management, and intraoperative findings were recorded. Fractures were classified as irreducible when documented closed reduction attempts failed, and open reduction was required to obtain satisfactory alignment. Results: Forty-one patients with rodeo-related injuries were identified. Orthopedic injuries occurred in 21 patients (51.2%), including 18 extremity fractures (43.9%). Thirteen of eighteen extremity fractures (72.2%) were managed operatively. Open reduction after unsuccessful closed reduction attempts was required in 5 of 13 operatively treated fractures (38.5%), representing 27.8% of all extremity fractures. Irreducible injuries included femoral shaft fractures, elbow fracture-dislocations, Monteggia injuries, proximal humerus fractures, and both-bone forearm fractures. Conclusion: Pediatric and adolescent rodeo-related extremity fractures were frequently managed operatively, and open reduction was required in a substantial proportion of surgically treated cases. These findings should be interpreted descriptively because no matched comparison cohort was available. Significance of study: This single-center series suggests that failed closed reduction may occur in several pediatric and adolescent rodeo-related extremity fracture patterns. Level of evidence: IV (Therapeutic Case Series)