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Peer-reviewedCC BY-NC-NDJournal of the Pediatric Orthopaedic Society of North America

A Review of Orthopaedic Trauma Injuries in Amish Pediatric Patients.

  • Kaitlyn A Reif1
  • Taylor G Landis2
  • Laura E Bess2
  • Robert G Tysklind2,3
  • Erika L Daley2,3
  • Robert J Bielski2,3
  1. 1Indiana University School of Medicine, Indianapolis, Indiana, USA.
  2. 2Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
  3. 3Department of Pediatric Orthopedics and Sports Medicine, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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Abstract

Amish children may experience traumatic orthopaedic injuries related to agriculture and other high-energy mechanisms unique to their communities. Geographic, cultural, and health care access factors may influence care. Despite this, orthopaedic literature describing pediatric trauma within Amish communities remains limited. This study characterizes traumatic orthopaedic injury patterns, clinical presentation, barriers to care, vaccination status, and follow-up rates among Amish pediatric patients treated at a level 1 pediatric trauma hospital. This is a retrospective descriptive case series of 58 Amish pediatric patients with traumatic orthopaedic injuries treated at a level 1 children's hospital. Patients were identified through the institutional trauma data base and using documented Amish/self-pay status in the insurance section of each patient's chart on the electronic medical record. Information including demographic data, injury presentation and pattern, vaccination status, and follow-up characteristics were collected through chart review. Treatment was categorized as operative or nonoperative, and findings were interpreted descriptively. Among 58 Amish pediatric trauma patients, 48 (82.8%) required operative management. Most were male (n ​= ​43, 74.1%) and 1-5 years old (n ​= ​25, 43.1%). The majority (n ​= ​45, 77.6%) initially presented to an outside hospital, with a mean distance of approximately 100 miles to the tertiary referral center. Nearly all patients were unvaccinated (n = 51, 87.9%). Among patients requiring surgery, lower extremity injuries were most common (n ​= ​26, 54.2%), with 11 open fractures (22.9%) and 6 amputations (12.5%). Pediatric intensive care unit admission occurred in 8 patients (13.8%), and 22 (37.9%) were lost to follow-up. Mean Injury Severity Score was 9.1 across all patients. Traumatic orthopaedic injuries in this Amish pediatric case series were characterized by frequent operative management, initial outside hospital presentation, high morbidity, and substantial loss to follow-up after inpatient discharge. It is critical to address vaccination status and provide tetanus prophylaxis given patients' low immunization rates and the farm- and soil-related contamination risks with open fractures. These findings may inform targeted injury prevention initiatives and strategies to improve continuity of care and long-term outcomes. (1)Amish pediatric patients are at increased risk for traumatic orthopaedic injuries, which are commonly related to their agricultural environments, animal interactions, preferred modes of transportation, and farm equipment and machinery.(2)Amish children with traumatic orthopaedic injuries frequently require transfer from regional hospitals to tertiary referral centers, resulting in extended time from injury to definitive care.(3)Most Amish children who presented to a tertiary referral center with traumatic orthopaedic injuries required operative intervention.(4)Vaccination rates are extremely low among Amish pediatric patients, necessitating frequent tetanus prophylaxis, particularly among those with amputations and open fractures.(5)Loss to follow-up is regularly seen among operative and nonoperative trauma in Amish pediatric patients (total loss to follow-up of 37.9% in our data), which may be a major barrier to comprehensive and longitudinal care. III, Retrospective Cohort Study.

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Cite

BibTeXRIS
BibTeX
@article{reif2026review,
  title = {{A Review of Orthopaedic Trauma Injuries in Amish Pediatric Patients.}},
  author = {Kaitlyn A Reif and Taylor G Landis and Laura E Bess and Robert G Tysklind and Erika L Daley and Robert J Bielski},
  journal = {Journal of the Pediatric Orthopaedic Society of North America},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jposna.2026.100475},
  url = {https://europepmc.org/article/MED/42997005},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - A Review of Orthopaedic Trauma Injuries in Amish Pediatric Patients.
AU  - Kaitlyn A Reif
AU  - Taylor G Landis
AU  - Laura E Bess
AU  - Robert G Tysklind
AU  - Erika L Daley
AU  - Robert J Bielski
PY  - 2026
DA  - 2026/10/03
JO  - Journal of the Pediatric Orthopaedic Society of North America
DO  - 10.1016/j.jposna.2026.100475
UR  - https://europepmc.org/article/MED/42997005
AB  - Amish children may experience traumatic orthopaedic injuries related to agriculture and other high-energy mechanisms unique to their communities. Geographic, cultural, and health care access factors may influence care. Despite this, orthopaedic literature describing pediatric trauma within Amish communities remains limited. This study characterizes traumatic orthopaedic injury patterns, clinical presentation, barriers to care, vaccination status, and follow-up rates among Amish pediatric patients treated at a level 1 pediatric trauma hospital. This is a retrospective descriptive case series of 58 Amish pediatric patients with traumatic orthopaedic injuries treated at a level 1 children's hospital. Patients were identified through the institutional trauma data base and using documented Amish/self-pay status in the insurance section of each patient's chart on the electronic medical record. Information including demographic data, injury presentation and pattern, vaccination status, and follow-up characteristics were collected through chart review. Treatment was categorized as operative or nonoperative, and findings were interpreted descriptively. Among 58 Amish pediatric trauma patients, 48 (82.8%) required operative management. Most were male (n ​= ​43, 74.1%) and 1-5 years old (n ​= ​25, 43.1%). The majority (n ​= ​45, 77.6%) initially presented to an outside hospital, with a mean distance of approximately 100 miles to the tertiary referral center. Nearly all patients were unvaccinated (n = 51, 87.9%). Among patients requiring surgery, lower extremity injuries were most common (n ​= ​26, 54.2%), with 11 open fractures (22.9%) and 6 amputations (12.5%). Pediatric intensive care unit admission occurred in 8 patients (13.8%), and 22 (37.9%) were lost to follow-up. Mean Injury Severity Score was 9.1 across all patients. Traumatic orthopaedic injuries in this Amish pediatric case series were characterized by frequent operative management, initial outside hospital presentation, high morbidity, and substantial loss to follow-up after inpatient discharge. It is critical to address vaccination status and provide tetanus prophylaxis given patients' low immunization rates and the farm- and soil-related contamination risks with open fractures. These findings may inform targeted injury prevention initiatives and strategies to improve continuity of care and long-term outcomes. (1)Amish pediatric patients are at increased risk for traumatic orthopaedic injuries, which are commonly related to their agricultural environments, animal interactions, preferred modes of transportation, and farm equipment and machinery.(2)Amish children with traumatic orthopaedic injuries frequently require transfer from regional hospitals to tertiary referral centers, resulting in extended time from injury to definitive care.(3)Most Amish children who presented to a tertiary referral center with traumatic orthopaedic injuries required operative intervention.(4)Vaccination rates are extremely low among Amish pediatric patients, necessitating frequent tetanus prophylaxis, particularly among those with amputations and open fractures.(5)Loss to follow-up is regularly seen among operative and nonoperative trauma in Amish pediatric patients (total loss to follow-up of 37.9% in our data), which may be a major barrier to comprehensive and longitudinal care. III, Retrospective Cohort Study.
SN  - 2768-2765
ER  -