Sociodemographic factors influence the risk for femur shaft fractures in children: a Swedish case-control study, 1997-2005

Epidemiology of Pediatric Fractures and Effect of Socioeconomic Status on Fracture Incidence in Türkiye: A Nationwide Analysis of 2 Million Fractures

BACKGROUND

Childhood fractures are an important public health issue worldwide as they potentially lead to long-term complications. This is the first study reporting a nationwide data pool of 2 million children. We aimed to investigate the epidemiology of pediatric fractures by sex, age, geographical region, and socioeconomic status (SES).

METHODS

Medical records of children diagnosed with fractures between 2016 and 2022 were collected from Türkiye's e-health database. Fractures were divided into 16 anatomic locations. Age was evaluated in four categories: <5, 5-9, 9-14, and 15-19 years. Regional rankings were stratified based on SES.

RESULTS

A total of 1,989,212 pediatric fractures were analyzed (1,371,398 boys, 617,814 girls). The overall fracture incidence was 1117/100,000 person-years, being higher for boys (n=1501) compared with girls (n=713) ( P <0.001). The mean fracture incidence between 0 and 19 years of age was 21.2% (boys: 28.5%; girls: 13.5%). The overall fracture incidence increased with age, peaking at 10 to 14 years for all children and decreasing thereafter. The 4 most common fracture locations were in the upper extremities. Wrist fractures accounted for 28.9% (575,192) of all pediatric fractures. Provinces with higher SES had significantly increased fracture risks.

CONCLUSIONS

This study provides the most accurate epidemiological analysis of childhood fractures in the Turkish population with landmark nationwide analysis for the pediatric literature. One fifth of children experienced fractures before maturity. The results highlight the influence of SES on fracture rates, as children in more urbanized and developed areas had an elevated risk of fractures.

LEVEL OF EVIDENCE

Level III-diagnostic.

Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review

Introduction

Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES.

Methods

A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance.

Results

Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures.

Conclusion

Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

[Femoral shaft fractures in children under 3 years old. Current treatment standard]

INTRODUCTION

Femoral shaft fractures in children are a common injury. Operative treatment is recommended for children above 3 years of age. The question of this investigation was the current clinical standard for the treatment of femoral shaft fractures in children under 3 years old.

MATERIAL AND METHODS

An e-mail questionnaire was sent to all clinics and hospital departments of the members of the German Society for Trauma Surgery and the German Society of Pediatric Surgery.

RESULTS

Out of 775 clinics and departments, 121 participated in the survey (16 %). From 2011 to 2012 overall 756 femoral shaft fractures of children 3 years and younger were treated of which 375 (50 %) were stabilized with elastic stable intramedullary nailing (ESIN), 183 (24 %) with an overhead extension, 178 (23 %) with a plaster cast and 9 (1 %) with external fixation. Finally, operative treatment was used in 51 % compared to 49 % with conservative treatment.

DISCUSSION

Obviously, operative treatment of femoral shaft fractures in children younger than 3 years is routinely used despite the fact that there is no evidential basis for this approach. There are good arguments for and against operative and conservative forms of treatment. Indications for operative treatment include multiple trauma, open fractures, body weight over 20 kg, child already free walking and lack of stable fixation with conservative treatment. To achieve more evidence for the existing recommendation of the American Academy of Orthopaedic Surgeons (AAOS) and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, Working Group of the Scientific Medical Specialist Societies), further investigations are needed.

Pediatric fractures through the eyes of parents: an observational study

The present study is an observational cross-sectional study. The main purpose of this research was to analyze the perception and behaviors of parents in a series of pediatric upper extremity fracture cases. Hundred and seventeen patients younger than 12 years who were conservatively treated for the upper extremity fracture were included in our study. Parents of the patients were requested to answer a family-centered questionnaire related to their child's fracture and its treatment. When the parents were asked whether they believe casting would be sufficient or not as the treatment of their child's fracture, 84.6% answered 'yes', 13.7% answered 'I am not sure,' and 1.7% answered 'no.' Sixty-four of the parents were not worried about any residual defect in joint or extremity functions related to fracture, whereas 21 were worried and 32 were not sure on this. The rate of searching further information about the child's fracture was 34.2% and the mostly used source was the Internet. Twenty-eight of the 117 respondents (23.9%) emphasized that they would reduce the time their child spend outside the home at least for a while after the removal of cast. When conservatively treating a child's fracture, physicians dealing with traumatology should always consider the parents' perception and behaviors as critically important.

Femur shaft fracture at a young age and the risk of subsequent severe injuries during childhood: a cohort study

BACKGROUND

A child who suffers a fracture or a soft-tissue injury at a young age faces an increased risk of subsequent injuries during childhood. This risk could be related to personal and family characteristics or to lower-than-average bone-mineral density. The purpose of this nationwide cohort study was to estimate the association between a femur shaft fracture at a young age and the subsequent risk of hospitalization for injuries during childhood.

METHODS

We compared the subsequent risk of hospitalization for injuries during childhood among 1,404 children (exposed) who were one to three years of age when they suffered a femur shaft fracture with the risk among 13,814 randomly selected, gender- and age-matched femur fracture-free children (unexposed). Hazard ratios (HRs) and 95% confidence intervals (CIs) for severe injuries defined as fractures or soft-tissue injuries requiring hospital admission were estimated in a Cox proportional hazards model.

RESULTS

Exposed children exhibited no significantly increased risk of upper-extremity fractures or soft-tissue injuries during childhood, regardless of sex and follow-up time. Boys exhibited a 162% increased risk of suffering a lower leg fracture requiring hospital admission (HR?=?2.62, 95% CI: 1.45-4.71), but the refracture risk was not significant for girls 2.02 (0.58-6.97).

CONCLUSIONS

We found an increased risk for subsequent fractures in the lower leg that requires inpatient care during childhood for boys, but not for girls, who were one to three years of age when they first suffered a femur shaft fracture. This increased fracture risk is probably not simply the result of greater risk-taking among boys. The explanation might relate to factors affecting the bone quality of the lower leg.