Epidemiologic Features of Traumatic Fractures in Children and Adolescents: A 9-Year Retrospective Study

Epidemiology of injuries among children and adolescents from the Xinglin District in Xiamen, 2016-2019

Objective

To investigate the epidemiology of injuries among children and adolescents in the Xinglin District of Xiamen from 2016 to 2019.

Methods

This study collected data from patients who attended the outpatient and emergency departments of the Xinglin District at the First Affiliated Hospital of Xiamen University between January 2016 and December 2019, diagnosed with injuries.

Results

A total of 13,123 patients were included, categorized into age groups 0-4 (n = 4,834), 5-9 (n = 3,924), 10-14 (n = 2,671), and 15-18 (n = 1,694). The rates of unintentional injuries were 97.00%, 96.94%, 94.50%, and 90.08% in the 0-4, 5-9, 10-14, and 15-18 age groups, respectively (P < 0.001). The proportion of head injuries decreased with age (from 41.13% in the 0-4 age group to 18.00% in the 15-18 age group), compensated by an increase in rates of injuries to upper and lower extremities and multisite injuries (P < 0.001). The most common causes of injuries were fall-related injuries (30.46%-52.05%), followed by mechanical injuries (18.35%-36.42%), with the rates of fall-related injuries decreasing with age and rates of mechanical injuries increasing with age (P < 0.001). Age-period-cohort models revealed that the time factor was not significant for fall-related injuries and mechanical injuries (all P > 0.05) despite apparent increases in incidence over time.

Conclusion

Injuries in children and adolescents continue to be a significant public health concern in the Xinglin District (China), predominantly driven by fall-related injuries and mechanical injuries.

Clinical Characteristics and Outcomes of Limb Fractures in Saudi Children

BACKGROUND

 Children's bones are at high risk of fracture as they grow. The clinical characteristics of fractures in children differ from those in adults. Studying fractures in healthy children is critical for identifying cases of fragility fractures. The aim of this study was to assess the clinical characteristics of limb fractures as well as clinical indicators of fracture healing outcomes in healthy Saudi children seen in an emergency room.

METHODS

A retrospective review of the treatment course of all pediatric fractures and related factors treated at King Abdullah Specialist Children's Hospital (KASCH) in Riyadh between 2016 and 2018 was conducted. Children with a primary bone disorder or chronic comorbidities known to affect bone health were excluded.

RESULTS

 The study included 143 patients (mean age ± SD = 8.23 + 3.76 years), and 71% (n = 102) were males. Motor vehicle accidents (MVAs) were the most common mechanism of injury, accounting for 50 (35%) cases, followed by fall injuries, sports injuries, and pedestrian accidents at 45 (31.4%), 16 (11.2%), and 13 (9.1%), respectively. A total of 178 fractures were reported, with the femur (n = 75, 42.1%) being the most common of the reported fracture sites, followed by the forearm (n = 44, 24.7%). The most common type of fracture was transverse fracture (n = 96, 54% of patients). Vitamin D levels were measured in 53/143 cases. Of these, vitamin D deficiency was found in 38 (71.7%) patients. The average time for fracture healing was 32.9 ± 30.2 weeks. The mechanisms of injury, including MVAs and sports injuries, as well as femur and forearm fractures, were clinical factors that were independently associated with a longer duration of fracture healing time (p < 0.001), but age, gender, and vitamin D status were not associated with that outcome.

CONCLUSION

 MVAs and fall injuries were the most common causes of fracture in our patients. MVAs and sports injuries were associated with prolonged healing time. Large prospective, multicenter, or field studies may be required to further explore clinical characteristics, outcomes, and environmental factors.

Comparison of ultrasonography and conventional radiography in the diagnosis of extremity fractures in the emergency department

Objective: The purpose of the study is to compare the diagnostic accuracy (sensitivity and specificity) of ultrasonography (USG) with that of conventional radiography (CR), the standard imaging modality used to diagnose acute extremities fractures. Materials and Methods: The prospective investigation examined 245 patients with clinical symptoms of an extremity fracture. Radiography (anteroposterior and lateral radiographs for each patient, oblique if necessary) and USG were performed on all participants and compared with all the results. Results: CR verified 98.5% of 132 patients who were determined to have extremities fractures with USG. CR, on the other hand, confirmed 99.1% of 112 patients who were reported to have no extremities fractures by USG. The sensitivity (detection of fractures based on USG of patients with fractures detected based on the CR imaging) was 99.2% (95%CI=95.8-99.9); selectivity (no fracture was detected based on USG of patients with no fracture detected based on the CR imaging) was 98.2% (95%CI=93.8-99.7); the positive predictability was 98.48% (95%CI=94.2-99.6), whereas the negative predictability value was 99.1%(95%CI=94-99.8). Conclusion: USG and CR showed similar diagnostic performances in the diagnosis of extremity fractures. USG can be considered an alternative to CR in the examination of extremity fractures with comparable diagnostic performance.

Epidemiology and treatment of pediatric tibial fractures in Sweden: a nationwide population-based study on 5828 fractures from the Swedish Fracture Register

Purpose

Pediatric tibial fractures have been described internationally as mainly caused by fall during leisure activities and organized sports and showing a higher incidence in boys. Still, most studies are single center studies or have a small sample size. This study aimed to analyze sex and age distribution, seasonal variation, injury mechanisms and treatment of pediatric tibial fractures based on the nationwide Swedish Fracture Register (SFR).

Methods

All tibial fractures in patients < 16 years at injury and registered in 2015–2019 were extracted from the SFR. We analyzed patient characteristics such as sex and age, injury mechanism, fracture location and treatment.

Results

The study cohort consisted of 5828 pediatric tibial fractures in 5719 patients. Median age of the patients was 7 years and 58% were boys. Shaft fractures were most common, followed by the distal and proximal tibia. The lowest incidence was observed during autumn. The most common cause of injury was fall mostly involving winter sports, stumbles and fall from play equipment. Play/free time and sports were the most common activities, common places of injury were sports facility and home. 1% were open fractures. 78% were treated non-surgically. Screw fixation was performed in 52% of surgically treated fractures, predominantly in the distal segment.

Conclusion

Injury mechanism differs between age groups; play/free time injuries are common in younger children compared with sport activities in older children. Most patients are treated non-surgically. Open fractures are rare. Information on injury patterns is useful working preventively, for example safety work in playgrounds.

Fractures of limbs specific to children: the experience of a Senegalese tertiary hospital

Introduction

Fractures specific to the pediatric age group represent a particular injury due to their pattern, diagnosis, management, and outcomes. In sub-Saharan Africa, studies on this particular injury are scarce. This study reports sociodemographic, diagnostic, and therapeutic aspects and outcomes of these fractures.

Methods

We conducted a descriptive cross sectional study at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Dakar, Senegal, from January 2012 to December 2015.

Results

A fracture specific to children was diagnosed in 180, of whom 47.7% were school-aged, with 59.4% of males. The mean time from injury to the attendance of our department was 48.2 h. Domestic accidents occurred in 51.1%. A total of 243 fractures occurred, mainly on the upper limbs (75.3%), as the most affected bones were the radius (47.3%), ulna (22.6%), and tibia (13.6%). Greenstick fractures represented 46.9%, buckle fractures, 42.8%, plastic deformations 9%, and subperiosteal fractures 0.7%. In all patients, management was orthopedic, with associated analgesic treatment. No sequel nor other complication was registered.

Conclusion

Fractures proper to the child are a particular entity in children’s trauma, frequently happening in boys, with greenstick and buckle fractures being the most common. Their treatment is exclusively orthopedic, with excellent outcomes.

Isometric strength of upper limb muscles in youth using hand-held and hand-grip dynamometry

The present study aimed to determine the isometric strength profile of the upper limb muscles of children and adolescents between 7–15 years of age. Furthermore, to (a) identify the age at which differences in strength are observed between sexes; to (b) determine the age range at which significant progression of strength could be observed; and (c) identify the role of each muscle on the total upper limb strength. Cross-sectional study that evaluated the isometric strength of nine muscle groups of the upper limb of 243 Chilean children, split into 9 age groups, separated by 1-year intervals. For this, hand-held dynamometry and hand-grip dynamometry were used. A two-factor analysis of variance for the maximum isometric strength and a stepwise multiple linear regression analysis were performed. From 11 years of age, wrist flexors were the first muscle group that revealed a significant difference in isometric strength in favor of boys (P=0.0143). In boys, the narrowest and earliest age range in the progression of isometric strength was 10 to 12 years for wrist flexors (P=0.0392). Shoulder flexors was the main factor that explained the performance of the total upper limb strength (R²=0.742; P<0.001). The most progressive isometric strength development occurred from age 10 years in the ventral and distal muscles of the upper limb; and from this age the boys begin to present a greater isometric strength than girls. In addition, the isometric strength of shoulder flexors explained the higher total upper limb strength performance.

Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study

INTRODUCTION

Recent studies investigating the frequency of paediatric fractures in Germany are not available. The primary aim of this study was to report frequencies of the most common paediatric upper extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time.

METHODS

This study used inpatient data from the German National Hospital Discharge Registry. Absolute frequencies and incidences of the following fracture localisations were analysed: clavicle, proximal humerus, humerus shaft, distal humerus, ulna shaft, radius shaft, forearm shaft, distal radius, and distal forearm. Four age groups were formed: 0-4, 5-9, 10-14, and 15-19 years. The boy-girl ratio (BGR) was calculated for all fracture localisations for both years, respectively. Incidence rate ratios (IRRs) were calculated to compare fracture incidences between 2002 and 2017.

RESULTS

The absolute number of the nine fracture localisations together decreased from 38,480 in 2002 to 35,128 in 2017. The overall BGR was 2.0 in both years. The BGR increased with increasing patient age. The incidence of clavicle fractures increased from 2002 to 2017 (IRR ≥ 1.72), while that of humerus fractures (proximal, shaft, and distal) remained the same or decreased (IRR ≤ 1.00) within all age groups. The incidence of isolated ulna or radius shaft fractures increased slightly or remained the same in the two lower age groups (IRR ≥ 1.00), while it decreased in the two higher age groups (IRR ≤ 0.80). Furthermore, complete forearm fractures were more frequent in the 0-4, 5-9, and 10-14 year age groups (IRR ≥ 1.44) in 2017 compared to 2002. The incidence of distal radius und forearm fractures changed only slightly.

CONCLUSIONS

The absolute number of paediatric upper extremity fractures decreased from 2002 to 2017, while the incidence of in-hospital treatment of clavicle and forearm fractures increased significantly, indicating a trend towards operative treatment.