Pediatric orthopedic all-terrain vehicle injury patterns, surgeries, and complications: appreciating the true morbidity and impact.

All-terrain vehicle (ATV) accidents frequently cause orthopedic injuries. Previous studies have reported the frequency of fractures in ATV injuries. No studies have provided detailed assessments of fracture patterns, types of operative intervention, or risks for multiple surgeries. A total of 489 patients with ATV-related injuries were treated at one tertiary Level 1 pediatric hospital from January 2011 to December 2016. Medical records were retrospectively reviewed to define orthopedic injuries and treatment. Data were organized to identify fracture patterns, surgeries, and complications. Three age groups were utilized (0-6, 7-12, and ≥13 years). A total of 270 pelvic and extremity fractures occurred in 215 patients (44%); 136 patients (63%) required surgical intervention; 47 patients (22%) required multiple trips to the operating room; 16% of fractures (43/270) were open, and seven developed deep infections. Three patients required amputations, and one death was recorded. No significant differences were found between age and fracture frequency or need for surgery. Surgical rates of supracondylar humerus (97%) and tibial shaft fractures (87%) were higher than historical norms (16-24% and 5-74%, respectively). To date, this is one of the largest single-institution cohorts of ATV-related pediatric orthopedic injuries. Nearly half of ATV-related pediatric trauma patients sustained orthopedic injuries. The majority required surgical treatment, and nearly 1/4 of patients required multiple surgeries. Younger patients were as likely to require surgery as older patients. Supracondylar humerus fractures and tibial shaft fractures from ATVs required surgery at a higher rate than historical norms. The surgical morbidity of pediatric ATV fractures is substantial and should influence safety and prevention education.