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Hepping AM, Barvelink B, Ploegmakers JJW, van der Palen J, Geertzen JHB, Bulstra SK, Harbers JS, Stevens M. Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study. Disabil Rehabil 2023; 45:3560-3566. [PMID: 36214289 DOI: 10.1080/09638288.2022.2131006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate. MATERIALS AND METHODS Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline. RESULTS Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only. CONCLUSIONS Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure.IMPLICATIONS FOR REHABILITATIONThis study relates to monitoring recovery from pediatric forearm fractures.Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered.Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS).To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.
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Affiliation(s)
- Ann M Hepping
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
| | - Britt Barvelink
- Department of Orthopedics, Erasmus Medical Center Rotterdam, The Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job van der Palen
- Section Cognition, Data and Education, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorrit S Harbers
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Granild-Jensen JB, Pedersen AB, Kristiansen EB, Langdahl B, Møller-Madsen B, Søndergaard C, Farholt S, Vestergaard ET, Rackauskaite G. Fracture Rates in Children with Cerebral Palsy: A Danish, Nationwide Register-Based Study. Clin Epidemiol 2022; 14:1405-1414. [DOI: 10.2147/clep.s381343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
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Clark P, Montiel-Ojeda D, Rascón-Pacheco RA, Guagnelli MA, Lopez-Gonzalez D, Bremer A, Borja-Aburto VH. Fracture incidence in children and adolescents 0-19 years old in Mexico: a 12-year cross-sectional analysis. Arch Osteoporos 2022; 17:127. [PMID: 36129580 DOI: 10.1007/s11657-022-01162-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/05/2022] [Indexed: 02/03/2023]
Abstract
The objective was to know the behavior of fractures in Mexican children and adolescents. According to our study, fractures in Mexican male children and adolescents seem to be decreasing; however, we still need more national studies to know the possible causes of these fractures. PURPOSE To describe the trends of fractures in Mexican children and adolescents across a 12-year period (2007 to 2019), and to analyze if these trends have changed over time between sexes and age groups. METHODS We identified all fracture cases registered in children and adolescents (0 to 19 years) at the emergency rooms and surgical departments of the Mexican Institute of Social Security between January 2007 and December 2019. We used ICD-10 to classify the fractures. The population was divided into two age groups: children (0 to 9 years) and adolescents (10 to 19 years). Additional information regarding sex and age was gathered up as well. We calculated annual incidence; incidence rates are presented per 10,000 population at risk. Changes in fracture trends were calculated using the average annual percentage change (AAPC). RESULTS Over 12 years, 1,400,443 fractures were registered. The most frequent site of fracture was forearm in 37.1% followed by shoulder (18.1%). The overall rates of fractures have remained similar over 12 years (86.5, IQR 81.0-94.2); however, a significant decrease in fractures was observed the last 3 years (2017-2019). According to the AAPC, only in men, in both age groups, a significant decrease in fractures was observed. CONCLUSION This is the first study in Mexico to follow the behavior of fractures in the pediatric population over 12 years. Fractures seem to be decreasing in children and adolescents. An epidemiological follow-up of childhood fractures is necessary to understand the causes of fractures to generate better prevention and treatment strategies.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
| | | | - Miguel A Guagnelli
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Desirée Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alhelí Bremer
- Faculty of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | - Víctor Hugo Borja-Aburto
- Teaching and Research Unit, Directorate of Medical Benefits, Mexican Institute of Social Security, IMSS, Mexico City, Mexico
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Linton G, Hägglund G, Czuba T, Alriksson-Schmidt AI. Epidemiology of fractures in children with cerebral palsy: a Swedish population-based registry study. BMC Musculoskelet Disord 2022; 23:862. [PMID: 36104768 PMCID: PMC9476295 DOI: 10.1186/s12891-022-05813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Children with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP. Methods This was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000–2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated for first-time fractures. Results Of the 3,902 participants, 368 (9.4%) had at least one reported fracture. The cumulative risk of sustaining a fracture before age 16 years was 38.3% (95% confidence interval 33.9–42.4). The hazard for fracture was 7 times higher in children with epilepsy. The overall fracture incidence was not statistically significantly related to sex or GMFCS level. Fractures in the upper extremities were most prevalent in children with a lower GMFCS level, and femoral fractures were most prevalent in children at GMFCS level V. Most fractures occurred in early childhood and after 8 years of age. Conclusions Children with CP were at similar risk of sustaining fractures as typically developing children, but the risk was higher in children with comorbid epilepsy. Fractures occurred in children at GMFCS levels I–III at sites similar to those for typically developing children; fractures in the upper extremities were the most frequent. Children at GMFCS levels IV or V and those with epilepsy were more likely to have a fracture in the lower extremities, and the femur was the most frequent site.
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Morohoshi A, Qureshi AR, Iseri K, Morohoshi H, Li Y, Lindholm B, Berg HE, Felländer-Tsai L. Secular trends in incidence and seasonal variation of distal radius fracture among children: A nationwide study based on the Swedish National Patient Register 2002-2016. Bone 2022; 162:116479. [PMID: 35787484 DOI: 10.1016/j.bone.2022.116479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Although distal radius fracture (DRF) is the most common fracture type in children, research on its seasonality across different age groups is limited. We investigated secular trends in incidence and seasonal variation of pediatric DRF based on Swedish nationwide population database. PATIENTS AND METHODS In this observational study, data for all children aged <18 years in Sweden with DRF defined by ICD-codes were analyzed for each month and each year during 2002-2016 using the Swedish National Patient Register. The general population counts for each age and sex-category were acquired to evaluate population at risk for each period. We calculated the age standardized and sex specific annual incidence rates, seasonal incidence rates, and monthly incidence rates and analyzed the seasonal variation in the mechanisms of injury. RESULTS A total of 155,891 DRF cases were identified. The age standardized and sex specific incidence rate was 531 (95%CI 528-533) per 100,000 patient years at risk. Fracture risk was highest during summer and lowest in the winter. The highest seasonal variation was observed among boys 2- < 5 years. The crude incidence rate and the age-standardized incidence rates in winter significantly decreased between 2002 and 2016 (annual percentage change, -2 %). INTERPRETATION We found significant seasonal variation in DRF among all age groups in Swedish children. The findings can help in developing strategies to prevent fractures as well as in allocating medical and social resources.
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Affiliation(s)
- Akiko Morohoshi
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Abdul Rashid Qureshi
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ken Iseri
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hokuto Morohoshi
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Japan
| | - Yan Li
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hans E Berg
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer-Tsai
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Zhi X, Xie D, Yang H, Hong K, Chen W, Xu H, Canavese F, Zhou Q. Clinical characteristics and distribution of paediatric hand fractures at a tertiary hospital in South China: a retrospective analysis. J Pediatr Orthop B 2022; 31:479-485. [PMID: 34723915 DOI: 10.1097/bpb.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the characteristics of paediatric hand fractures (PHF) at a tertiary hospital in South China based on sex, age, mechanism of injury and anatomical region. A retrospective observational study was performed on children aged 15 years and younger who were referred for actual or suspected hand fractures between January 2016 and December 2020. Medical records and radiographs were reviewed for age at the time of injury, sex, site and fracture pattern and mechanism of injury. A total of 436 consecutive children with 478 hand fractures were reviewed. Hand fractures was more common in boys (281/436; 64.4%) than in girls (155/436; 35.6%), although most fractures occurred in children aged 0-3 years (198/436; 45.4%). Distal phalanges were the most commonly injured bones (184/478; 38.5%), and the base fractures were most common (151/476; 31.7%); the fifth digit was most commonly injured (150/478; 31.3%). Crush injuries were the leading cause of fracture in children younger than 6 years of age (207/325; 63.7%), whereas punch injuries were the major cause of injury in older age groups (55/153; 35.9%); 60.1% of the fractures were managed nonsurgically. This study showed patterns of PHF in a tertiary hospital in South China. It illustrates the local variability across sex, age group, injury type and injury mechanism. Such demographic data will be valuable for optimally resourcing healthcare systems locally and help guide prevention policies.
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Affiliation(s)
- Xinwang Zhi
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dongming Xie
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Haiyi Yang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Kai Hong
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weidong Chen
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongwen Xu
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Qinghe Zhou
- Department of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Oh CH, Yoon S, Ko KR, Kwon YW, Kim KM, Park HS, Kang H, Jang I, Lee S. Epidemiology of pediatric fractures before versus during the coronavirus disease 2019 pandemic. Clin Exp Pediatr 2022; 65:330-336. [PMID: 35681247 PMCID: PMC9263426 DOI: 10.3345/cep.2021.01767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Several studies have reported changes in the prevalence of childhood fractures between the prepandemic and coronavirus disease 2019 pandemic periods considering the overall decrease in activity during the latter. This review aimed to organize and summarize the global trends in pediatric fracture incidence. Our findings should help predict fracture patterns in the postpandemic period by identifying changes in the past and present, thus aiding patient management.
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Affiliation(s)
- Chi Hoon Oh
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Rae Ko
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Woo Kwon
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Kyeong Mi Kim
- Department of Laboratory Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | | | | | - Inseok Jang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Qiu X, Deng H, Su Q, Zeng S, Han S, Li S, Cui Z, Zhu T, Tang G, Xiong Z, Tang S. Epidemiology and management of 10,486 pediatric fractures in Shenzhen: experience and lessons to be learnt. BMC Pediatr 2022; 22:161. [PMID: 35351043 PMCID: PMC8962138 DOI: 10.1186/s12887-022-03199-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures. Methods This study retrospectively analyzed the epidemiological characteristics of fractures in pediatric aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020. Results A total of 10,486 pediatric patients were included in the study, of whom 6961 (66.38%) were boys, and 3525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3843 sites, 27.49%), distal ulna (1740 sites, 12.44%), and distal radius (1587 sites, 11.35%). The top three causes of injury were falls (7106 cases, 82.10%), car accidents (650 cases, 65.72%), and clipping (465 cases, 5.37%). Fractures predominantly occurred between July and November (4664 cases, 48.87%) and on Saturdays and Sundays (3172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4339 cases, 45.46%). Conclusion For pediatric fractures, we should take appropriate and effective preventive measures to reduce the incidence of children’s fractures according to the distribution characteristics of age, gender, cause of injury, and fracture site. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03199-0.
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Eastman J, White H, Evans J, Augsburger S, Wallace J, Riley S, Iwinski H. What is the minimum torque required to obtain passive elbow end range of motion? Gait Posture 2022; 93:235-239. [PMID: 35190315 DOI: 10.1016/j.gaitpost.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Passive range of motion is a common clinical assessment. The point at which passive end range of motion is measured is typically described by the 'end-feel'of the joint. RESEARCH QUESTION What is the minimum amount of torque required to obtain passive elbow flexion and extension in children? METHODS Twenty-five children (age, 7.5 ± 1.6 years-old), who had previously sustained unilateral distal humeral fractures, participated in this prospective study.Passive elbow flexion and extension was measured at least 8 weeks and up to one year out of cast. Motion capture cameras were used to track twenty-one reflective markers placed on subjects and two markers attached to the pad of a force transducer.Five trials of passive range of motion (flexion and extension) were performed on both arms. Elbow joint moments were calculated as products of the forces applied and lengths to the elbow centers. A one way ANOVA was used to determine differences in moments for flexion and extension for both involved and uninvolved limbs. Pairedsamples t-tests were used to determine differences between the involved and the uninvolved limbs for both maximum flexion and extension. RESULTS There was no difference in the minimum mean joint moment (2.7 ± 1.1 Nm) at end range of motion. However, differences in passive range of motion was found between involved and uninvolved elbows (flexion p < .001; extension p = .001). SIGNIFICANCE The results demonstrate therapists obtained end range of passive elbow flexion and extension applying the same amount of minimum torque. A small torque is sufficient to achieve end range of elbow motion for children. This torque can be used in guiding clinical practice for assessing passive range of elbow motion in pediatric population. Because of a paucity of data for any joint, future research developing force data for other joints should be conducted.
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Affiliation(s)
- Joel Eastman
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Hank White
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA.
| | - Jenn Evans
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Sam Augsburger
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Juanita Wallace
- Department of Health and Exercise Science, Transylvania University, 300 North Broadway, Lexington, KY 40508, USA
| | - Scott Riley
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
| | - Henry Iwinski
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
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Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Seasonal variation in paediatric orthopaedic trauma Patients - A single centre experience from Turkey. J Orthop Surg (Hong Kong) 2022; 30:23094990211068146. [PMID: 35045744 DOI: 10.1177/23094990211068146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is known that the incidence of paediatric orthopaedic trauma peaks in the summer months as a result of increased and uncontrolled physical activity. The aim of this study was to review the experience of a single centre with paediatric orthopaedic traumas and determine the relationship between the severity and the variations in the incidence of traumas in relation to the seasons and temperatures during the study period. MATERIALS AND METHODS A single institutional review of the historical data of all patients aged 0-16 years who presented for orthopaedic trauma between January 2018 and December 2020 in the emergency department of Level 1 tertiary orthopaedic trauma centre was conducted. 65,182 paediatric orthopaedic trauma cases had been retrieved from the hospital data base during the 3 -year study period. We classified the traumas according to the variants of the patients' and by holidays, seasons, school days and weekends, months and in which part of the body it occurred. RESULTS After excluding the summer vacation, 77% of paediatric orthopaedic trauma patients attended to the hospital on weekdays and 23% on weekends. While it was observed that hot weather had a statistically positive effect on trauma attendance, rainy weather had an negative effect (p < 0.05). Trauma attendances were found to be statistically higher in summer months, except for injuries that may occur with indoor activities such as metacarpal fracture, phalanx fracture and pulled elbow (p < 0.05). CONCLUSION Orthopaedic trauma at a Level 1 tertiary health care trauma center do vary significantly with the weather and are highest in the summer season. Therefore, it should focus more attention on preventive strategies for paediatric trauma in the summer season.
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Affiliation(s)
- Anil Agar
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Adem Sahin
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Orhan Gunes
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Deniz Gulabi
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Cemil Erturk
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
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Zacay G, Dubnov-Raz G, Modan-Moses D, Tripto-Shkolnik L, Levy-Shraga Y. Epidemiology of childhood fractures in Israel during 2000-2019. Bone 2022; 154:116174. [PMID: 34508878 DOI: 10.1016/j.bone.2021.116174] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/19/2021] [Accepted: 09/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Differences have been reported in incidence rates of fractures in the pediatric population, between countries and over time. The aim of this study was to evaluate the incidence and characteristics of fractures over 20 years among Israeli children. METHODS Incidence rates of fractures were derived from the electronic database of Meuhedet Health Services, a health maintenance organization providing healthcare services to 1.2 million people in Israel. Demographic and clinical data were extracted of all the fractures in individuals aged <18 years during 2000-2019. Fracture sites were determined according to ICD9 definitions. Fracture data were analyzed by age, sex, season and sector (general Jewish population, ultra-orthodox Jews and Arabs). RESULTS During the study period 188,283 fractures occurred in 142,049 individuals. The most common were fractures of the upper limb (65%), followed by fractures of the lower limb [20%]. The overall fracture rate was 251 per 10,000 person- years (PY), and was higher for boys than girls (319 vs. 180 per 10,000 PY, p < 0.001). During 20 years, standardized fracture rates decreased significantly in the general Jewish population, among both boys (from 457 to 325 per 10,000 PY, p < 0.001) and girls (from 244 to 196 per 10,000 PY, p < 0.001); increased among ultra-orthodox Jewish boys (from 249 to 285 per 10,000 PY, p = 0.002) and girls (from 147 to 194 per 10,000 PY, p < 0.001); and did not change significantly among Arab boys and girls. The fracture rate peaked among girls aged 10-11 years and among boys aged 12-13 years. Seasonal variation showed a bimodal distribution with peaks during spring and autumn. CONCLUSIONS The incidence of pediatric fractures is affected by age, gender, sector and season. Recognition of fracture characteristics may help identify specific populations and conditions for targeted prevention strategies.
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Affiliation(s)
- Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel; Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Gal Dubnov-Raz
- Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel; Exercise, Nutrition and Lifestyle Clinic, Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dalit Modan-Moses
- Meuhedet Health Services, Tel Aviv, Israel; Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel; Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Liana Tripto-Shkolnik
- Meuhedet Health Services, Tel Aviv, Israel; Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel; Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Levy-Shraga
- Meuhedet Health Services, Tel Aviv, Israel; Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel; Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Schultz JD, Rees AB, Wollenman LC, McKeithan LJ, Tadepalli VR, Wessinger BC, Attipoe G, Gay JC, Martus JE, Moore-Lotridge SN, Schoenecker JG. Factors That Drive Annual Variation in Pediatric Elbow Fracture Occurrence, Severity, and Resource Utilization. J Pediatr Orthop 2021; 41:e755-e762. [PMID: 34325445 DOI: 10.1097/bpo.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elbow fractures are the most common pediatric fractures requiring operative treatment. To date, few studies have examined what annual factors drive pediatric elbow fracture incidence and no studies have examined which annual factors drive elbow fracture severity or resource utilization. The goal of this study was to not only document the annual patterns of pediatric elbow fracture incidence and severity but also the impact of these patterns on resource utilization in the emergency department, emergency medical service transportation, and the operating room (OR). METHODS Retrospective cohort study of 4414 pediatric elbow fractures from a single tertiary hospital (2007 to 2017). Exclusion criteria included outside treatment or lack of diagnosis by an orthopaedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Pearson correlations were used to analyze factors influencing fracture incidence, severity, and resource utilization. RESULTS Pediatric elbow fracture incidence positively correlated with monthly daylight hours, but significantly fewer elbow fractures occurred during summer vacation from school compared with surrounding in school months. While fewer overall fractures occurred during summer break, the fractures sustained were greater in severity, conferring higher rates of displacement, higher risk of neurovascular injury, and greater needs for emergency transportation and operative treatment. Yearly, elbow fractures required 320.6 OR hours (7.7% of all pediatric orthopaedic OR time and 12.3% of all pediatric orthopaedic operative procedures), 203.4 hospital admissions, and a total of 4753.7 miles traveled by emergency medical service transportation to manage. All-cause emergency department visits were negatively correlated with daylight hours, inversing the pattern seen in elbow fractures. CONCLUSION Increased daylight, while school was in session, was a major driver of the incidence of pediatric elbow fractures. While summer vacation conferred fewer fractures, these were of higher severity. As such, increased daylight correlated strongly with monthly resource utilization, including the need for emergency transportation and operative treatment. This study provides objective data by which providers and administrators can more accurately allocate resources. LEVEL OF EVIDENCE Level III-Retrospective comparative study.
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Affiliation(s)
| | | | | | | | | | | | - Graham Attipoe
- Vanderbilt University School of Medicine
- The Wharton School at the University of Pennsylvania, Philadelphia, PA
| | | | - Jeffrey E Martus
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Pediatrics
| | - Stephanie N Moore-Lotridge
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Center for Bone Biology, Nashville, TN
| | - Jonathan G Schoenecker
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt
- Department of Orthopaedics, Vanderbilt University Medical Center
- Departments of Pharmacology
- Pediatrics
- Pathology, Microbiology, and Immunology
- Center for Bone Biology, Nashville, TN
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Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950-2016. J Orthop Surg Res 2021; 16:245. [PMID: 33836797 PMCID: PMC8034127 DOI: 10.1186/s13018-021-02380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016. Patients and methods The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI. Results In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1. Conclusions Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016. Level of evidence III Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02380-y.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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14
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Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016. J Wrist Surg 2021; 10:129-135. [PMID: 33815948 PMCID: PMC8012093 DOI: 10.1055/s-0040-1720965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9-1.2 and girls IRR 1.1, 95% CI: 0.9-1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7-1.2) and girls (APC +0.6%, 95% CI: 0.3-0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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15
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Marson BA, Manning JC, James M, Ikram A, Bryson DJ, Ollivere BJ. Trends in hospital admissions for childhood fractures in England. BMJ Paediatr Open 2021; 5:e001187. [PMID: 34786491 PMCID: PMC8587381 DOI: 10.1136/bmjpo-2021-001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals. DESIGN The study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children. RESULTS During 2012-2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5-9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10-15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0-4) children has been increasing at a rate of 0.629 per 100 000 children per year. IMPLICATIONS The annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.
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Affiliation(s)
- Ben Arthur Marson
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Clinical Trials Unit, University of Nottingham School of Medicine, Nottingham, UK
| | - Adeel Ikram
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - David J Bryson
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Benjamin J Ollivere
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
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16
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Orces CH, Orces J. Trends in the U.S. Childhood Emergency Department Visits for Fall-Related Fractures, 2001-2015. Cureus 2020; 12:e11629. [PMID: 33376643 PMCID: PMC7755699 DOI: 10.7759/cureus.11629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective The study's objective is to examine national trends in emergency department visits for unintentional fall-related fractures among children aged 0 to 19 years between 2001 and 2015. Methods The National Electronic Injury Surveillance System - All Injury Program was used to generate national estimates of fall-related fractures treated in emergency departments. Subsequently, according to demographic characteristics, body parts, and sport activities, age-adjusted fracture rates were calculated using the 2000 U.S. population as the standard. The joinpoint regression program was used to examine the average annual percent change in fracture rates during the study period. Results An estimated 7.9 million emergency department visits for fall-related fractures among U.S. children occurred between 2001 and 2015. Overall, upper extremity fractures accounted for 70% of the cases. Trend analyses demonstrated that fracture rates markedly decreased among children aged 10 to 15 years by -2.5% (95% C: -3.4% to -1.6%) per year. After adjusting for age, boys' fracture rates decreased annually by -1.9% (95% CI: -3.1% to -0.6%), whereas the average decrease in girls was less accentuated by -1.4% (95% CI: -1.8% to -1.0%) per year. Notably, forearm/wrist fracture rates decreased annually by -2.4% (95% CI: -2.9% to -1.9%) from 2004 onwards. In contrast, head and neck fracture rates significantly increased on average by 2.6% (95% CI: 1.3% to 3.9%) per year. Conclusion Childhood emergency department visits for fall-related fractures significantly decreased in the U.S. between 2001 and 2015. However, further research is needed to determine factors related to upward trends in head/neck fractures seen during the study period.
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Affiliation(s)
| | - Jacques Orces
- Emergency Department, Nicklaus Children's Hospital, Miami, USA
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17
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Bergman E, Lempesis V, Nilsson JÅ, Jephsson L, Rosengren BE, Karlsson MK. Time trends in pediatric fractures in a Swedish city from 1950 to 2016. Acta Orthop 2020; 91:598-604. [PMID: 32589095 PMCID: PMC8023972 DOI: 10.1080/17453674.2020.1783484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - As previous studies indicate time trends in pediatric fracture incidence, we followed the incidence in a Swedish city between 1950 and 2016.Patients and methods - Malmö city, Sweden had 322,574 inhabitants in 2015. We used diagnosis registry, charts, and radiographs of the only city hospital to classify fractures in individuals < 16 years in 2014-2016, and compared these with data from 1950-2006. We used joinpoint regression to analyze time trends and present results as mean annual percentage changes (APC). Differences between periods are described as incident rate ratios (IRR). To describe uncertainty, 95% confidence intervals (CI) are used.Results - During 2014-2016 the pediatric fracture incidence was 1,786 per 105 person-years (boys 2,135 and girls 1,423). From 1950 onwards age-adjusted fracture incidence increased until 1979 in both boys (APC +1.5%, CI 1.2-1.8) and girls (APC +1.6%, CI 0.8-2.5). The incidence remained stable from 1979 to 2016 (APC in boys 0.0%, CI -0.3 to 0.3 and in girls -0.2%, CI -1.1 to 0.7). Age-adjusted incidence 2014-2016 was higher than 2005-2006 in girls (IRR 1.1, CI 1.03-1.3), but not in boys (IRR 1.0, CI 0.9-1.1).Interpretation - Fracture incidence was in girls higher in 2014-2016 than in 2005-2006. However, only with more than 2 measuring points are meaningful trend analyses possible. When we analyzed the period 1950-2016 with 17 measuring points and joinpoint regression, we found that fracture incidence increased in both sexes until 1979 but has thereafter been stable.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden,Correspondence:
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan-Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jephsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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18
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Larsen AV, Mundbjerg E, Lauritsen JM, Faergemann C. Development of the annual incidence rate of fracture in children 1980-2018: a population-based study of 32,375 fractures. Acta Orthop 2020; 91:593-597. [PMID: 32500789 PMCID: PMC8023904 DOI: 10.1080/17453674.2020.1772555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Pediatric fractures are a common cause of morbidity. So far, no larger Danish study has described the development in the incidence rates. Therefore, we describe the development in the incidence rates of pediatric fractures in the time period 1980-2018 and the frequency of the most common type of fractures.Patients and methods - This is a retrospective register study of all children aged 0-15 years with a fracture treated in the Emergency Department at Odense University Hospital, Denmark, between 1980 and 2018. For all cases, information on age, sex, date of treatment, diagnosis, and treatment was obtained from the patient registration system. Based on official public population counts we estimated age and sex-specific annual incidence rates.Results - 32,375 fractures were included. In the study period the incidence rate decreased by 12%. The incidence increased until the early 1990s. Thereafter incidence rates decreased until 2004-09, from then onward increasing towards the end of the study period. The highest age-specific incidence rate in boys of 522 per 10,000 person-years was at 13 years of age. In girls the age of the highest incidence rate decreased from 11 years in 1980 to 10 years in 2018. Fracture of the lower end of the forearm, the clavicle, and the lower end of the humerus had the highest single fracture incidence rates.Interpretation - The incidence rate of pediatric fractures decreased in the study period by 12%. The highest single fracture incidence rates were for fracture of the lower end of the forearm, the clavicle, and the lower end of the humerus. As the first longitudinal Danish study of pediatric fractures this study is a baseline for evaluating future interventions and future studies.
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Affiliation(s)
- Andreas V Larsen
- Accident Analysis Group, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense; ,Correspondence: @rsyd.dk
| | - Esben Mundbjerg
- Accident Analysis Group, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense;
| | - Jens M Lauritsen
- Accident Analysis Group, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense;
| | - Christian Faergemann
- Accident Analysis Group, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense; ,Section for Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
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19
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Lempesis V, Jerrhag D, Rosengren BE, Landin L, Tiderius CJ, Karlsson MK. Pediatric Distal Forearm Fracture Epidemiology in Malmö, Sweden-Time Trends During Six Decades. J Wrist Surg 2019; 8:463-469. [PMID: 31815060 PMCID: PMC6892656 DOI: 10.1055/s-0039-1692471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
Background The distal forearm fracture is the most common fracture in children. To allocate health care resources and evaluate if prevention strategies have been successful, it is essential to monitor changes in the epidemiology of common fractures. Methods Our hospital serves a city in which year 2006 included 276,244 inhabitants (49,664 <17 years of age). Through the hospital archives, we identified fractures sustained by individuals younger than 16 years during 2005 and 2006 and compared these with previous collected and published data from the same area and hospital for the period 1950 to 1994. We used official population data to estimate period-specific fracture rates and age and gender standardized time trends. We report rates as number of fractures per 100,000 person-years and changes between periods as rate ratios (RR) with 95% confidence intervals (CIs). Results We identified 521 distal forearm fractures, corresponding to a crude fracture incidence of 564/100,000 person-years (boys 719; girls 401). Age-adjusted fracture incidence was 70% higher in boys than in girls (RR 1.7; 95% CI 1.3-2.3). The age- and gender-adjusted hand fracture incidence was 40% higher in 2005-2006 than in 1950/1955 (RR 1.4; 95% CI 1.2 to 1.8) but no higher than 1993-1994 (RR 1.1; 95% CI 0.9-1.3). Fracture etiology of 2005 to 2006 included sports injuries in 41% and traffic accidents in 11% of the cases, while sports injuries explained 37% and traffic accidents 18% in 1950 to 1955. Conclusion In 2005 to 2006, we found higher rates in boys and higher overall rates compared with the 1950s but no significant differences compared with the rates in 1993 to 1994. Future studies should include patient-specific data to unravel causal factors. Level of evidence This is a Level III b study.
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Affiliation(s)
- Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Carl Johan Tiderius
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
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20
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Escott BG, To T, Beaton DE, Howard AW. Risk of Recurrent Fracture: A Population-Based Study. Pediatrics 2019; 144:peds.2017-2552. [PMID: 31308257 DOI: 10.1542/peds.2017-2552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if children who sustain a fracture in childhood had an increased rate of fracture later in childhood or early adulthood. The a priori null hypothesis was that children who sustained a fracture would not have an increased rate of future fractures compared with children who did not sustain a fracture when controlling for important covariates. METHODS This is a population-based retrospective cohort study using health care databases in Ontario. Approximately 2.5 million healthy children aged 0 to 15 years living in Ontario, Canada between April 1, 2003, and March 31, 2004, were included and followed for 7 years. The exposure was occurrence of any fracture during a 1-year baseline period. The main outcome was any fractures during a 7-year follow-up period. RESULTS A total of 43 154 children suffered a fracture during the baseline year (17.5 fractures per 1000 child years). Children with a baseline fracture had a 60% higher rate of fracture (incidence rate ratio: 1.60; 95% confidence interval: 1.46-1.75; P < .0001) during the follow-up period after adjustment for sex, rurality, history of previous fracture, and the occurrence of other injuries (head and soft-tissue). CONCLUSIONS The occurrence of a fracture during childhood was associated with an increased rate of future fractures compared with children who did not suffer a fracture. Attempting to improve childhood bone health by targeting children who present to a fracture clinic with multiple fracture risk factors may be a useful strategy for secondary prevention of fractures and may have beneficial effects on long-term bone health.
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Affiliation(s)
- Benjamin G Escott
- Division of Orthopedic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Teresa To
- Child Health and Evaluative Sciences and
| | - Dorcas E Beaton
- Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Andrew W Howard
- Child Health and Evaluative Sciences and.,Department of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Canada; and
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21
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Zimmermann EA, Riedel C, Schmidt FN, Stockhausen KE, Chushkin Y, Schaible E, Gludovatz B, Vettorazzi E, Zontone F, Püschel K, Amling M, Ritchie RO, Busse B. Mechanical Competence and Bone Quality Develop During Skeletal Growth. J Bone Miner Res 2019; 34:1461-1472. [PMID: 30913317 DOI: 10.1002/jbmr.3730] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 02/01/2023]
Abstract
Bone fracture risk is influenced by bone quality, which encompasses bone's composition as well as its multiscale organization and architecture. Aging and disease deteriorate bone quality, leading to reduced mechanical properties and higher fracture incidence. Largely unexplored is how bone quality and mechanical competence progress during longitudinal bone growth. Human femoral cortical bone was acquired from fetal (n = 1), infantile (n = 3), and 2- to 14-year-old cases (n = 4) at the mid-diaphysis. Bone quality was assessed in terms of bone structure, osteocyte characteristics, mineralization, and collagen orientation. The mechanical properties were investigated by measuring tensile deformation at multiple length scales via synchrotron X-ray diffraction. We find dramatic differences in mechanical resistance with age. Specifically, cortical bone in 2- to 14-year-old cases exhibits a 160% greater stiffness and 83% higher strength than fetal/infantile cases. The higher mechanical resistance of the 2- to 14-year-old cases is associated with advantageous bone quality, specifically higher bone volume fraction, better micronscale organization (woven versus lamellar), and higher mean mineralization compared with fetal/infantile cases. Our study reveals that bone quality is superior after remodeling/modeling processes convert the primary woven bone structure to lamellar bone. In this cohort of female children, the microstructural differences at the femoral diaphysis were apparent between the 1- to 2-year-old cases. Indeed, the lamellar bone in 2- to 14-year-old cases had a superior structural organization (collagen and osteocyte characteristics) and composition for resisting deformation and fracture than fetal/infantile bone. Mechanistically, the changes in bone quality during longitudinal bone growth lead to higher fracture resistance because collagen fibrils are better aligned to resist tensile forces, while elevated mean mineralization reinforces the collagen scaffold. Thus, our results reveal inherent weaknesses of the fetal/infantile skeleton signifying its inferior bone quality. These results have implications for pediatric fracture risk, as bone produced at ossification centers during children's longitudinal bone growth could display similarly weak points. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Christoph Riedel
- Department of Osteology and Biomechanics, University Medical Center, Hamburg, Germany
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center, Hamburg, Germany
| | - Kilian E Stockhausen
- Department of Osteology and Biomechanics, University Medical Center, Hamburg, Germany
| | - Yuriy Chushkin
- Beamline ID 10, European Synchrotron Radiation Facility, Grenoble, France
| | - Eric Schaible
- Experimental Systems Group, Advanced Light Source, Berkeley, CA, USA
| | - Bernd Gludovatz
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, NSW, Australia
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg, Germany
| | - Federico Zontone
- Beamline ID 10, European Synchrotron Radiation Facility, Grenoble, France
| | - Klaus Püschel
- Department of Forensic Medicine, University Medical Center, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center, Hamburg, Germany
| | - Robert O Ritchie
- Department of Materials Science and Engineering, University of California, Berkeley, CA, USA.,Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center, Hamburg, Germany
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Lempesis V, Rosengren BE, Landin L, Tiderius CJ, Karlsson MK. Hand fracture epidemiology and etiology in children-time trends in Malmö, Sweden, during six decades. J Orthop Surg Res 2019; 14:213. [PMID: 31299998 PMCID: PMC6626361 DOI: 10.1186/s13018-019-1248-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to describe hand fracture epidemiology/etiology in city children and describe time trend during six decades. PATIENTS AND METHODS A single hospital serves the entire city population of 271,271 (year 2005). Through the hospital medical and radiological archives, we collected epidemiology and etiology data concerning pediatric (age < 16 years) hand fractures in city residents, treated during 2005-2006. We compared these data to previously collected data in in the same city during 12 evaluated periods from 1950/1955 to 1993-1994. We present period-specific crude and age- and gender-adjusted fracture incidence rates and group differences as incidence rate ratios (RR) with 95% confidence intervals (95% CI). RESULTS In 2005-2006, we identified 414 hand fractures (303 in boys and 111 in girls), 247 phalangeal fractures (60% of all hand fractures), 140 metacarpal/carpal fractures (except the scaphoid bone) (34%), and 27 scaphoid fractures (6%). The crude hand fracture rate in children was 448/100,000 person years (639/100,000 in boys and 247/100,000 in girls), with a 2.5 times higher age-adjusted incidence in boys than in girls. Compared to 1950/1955, the age and gender-adjusted hand fracture incidence was twice as high in 2005-2006 and more than twice as high in 1976-1979. Compared to 1976-1979, we found no significant difference in the age and gender-adjusted hand fracture incidence in 2005-2006. In 2005-2006, sports injuries explained 42%, fights 20%, and traffic accidents 13% of the hand fractures. In 1950/1955, sports injuries explained 27% of fractures, fights 10%, and traffic accidents 21%. CONCLUSIONS The incidence of hand fractures in children was more than twice as high in the end of the 1970s compared to the 1950s, where after no significant change could be found. Also, fracture etiology has changed. New studies are needed, to adequately allocate health care resources and identify new fracture prone activities suitable for preventive measures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Carl Johan Tiderius
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus. Sci Rep 2019; 9:8602. [PMID: 31197215 PMCID: PMC6565623 DOI: 10.1038/s41598-019-45157-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
This study aimed to discuss the effects of one stage surgical treatment by simultaneous osteotomy and asymmetric lengthening by Ilizarov external fixator on short femur with severe deformity of genu valgus. A total of 12 cases with unilateral deformities treated by simultaneous osteotomy and Ilizarov asymmetric lengthening on short femur with severe deformity of genu valgus were retrospectively analyzed from January 2006 to April 2015. The affected limbs were 2.5–11 cm (5.2 cm on average) short, the femorotibial angle was 135°–158° (146.3° on average), and the ankle interval was 15–43 cm (24.7 cm on average). The Paley method was used to determine the osteotomy plane (distal femur) of genu valgus. According to this standard, the bone union results were as follows: 11 had excellent and 1 had good, where 7 patients had excellent and 5 had good functional outcomes. One stage surgical treatment by simultaneous osteotomy and asymmetric lengthening on short femur with severe deformity of genu valgus was considered to be an effective and reliable method with better osteotomy union, less trauma and fewer complications.
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24
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Grgic O, Chung K, Shevroja E, Trajanoska K, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C. Fractures in school age children in relation to sex and ethnic background: The Generation R Study. Bone 2019; 121:227-231. [PMID: 30677542 DOI: 10.1016/j.bone.2019.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Abstract
Fracture rate in childhood is increasing and its consequences may affect health and developmental processes and cause school absence and restricted activity days. There are scarce epidemiologic studies regarding fractures in children. The aim of this study was to evaluate if pediatric fractures show disparities across sexes and ethnic groups. This study was conducted based on data from 3632 participants of the Generation R Study. Prevalent fractures were assessed using a questionnaire at a mean age of 9.7 years. Child's ethnicity was determined based on country of birth of the parents using questionnaires (geographic ancestry) or admixture analysis (genetic ancestry). Associations between fracture occurrence and sex or ethnicity were evaluated using logistic regression models adjusted for age, weight, lean mass fraction, bone mineral density (BMD) and sex/ethnicity. Fracture was reported for 525 (14.5%) children. The great majority of these children were classified as European (N = 3164), followed by African (N = 283) and Asian (N = 185) based on geographic ancestry. Similarly, the highest proportion of Europeans was observed based on genetic ancestry. Prevalence of fractures was not different between boys and girls, even after adjustment for possible confounders (OR: 1.03, 95% CI 0.84-1.27, p-value = 0.8). However, odds of prevalent fractures were two times higher in European when compared to Asian children (OR: 2.01, 95% CI 1.17-3.45, p-value = 0.01), and 1.5 times higher when compared to African children (OR: 1.50, 95% CI 1.00-2.26, p-value = 0.05). Overall, in this study, European children showed a highest risk of prevalent fractures independently of factors such as body composition and BMD, while no difference in the prevalence of fractures between boys and girls was observed.
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Affiliation(s)
- Olja Grgic
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Maxillo-Facial Surgery, Special Dental Care and Orthodontics, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands
| | - Kuan Chung
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Enisa Shevroja
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands.
| | - Katerina Trajanoska
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Andre G Uitterlinden
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Eppo B Wolvius
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Maxillo-Facial Surgery, Special Dental Care and Orthodontics, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands.
| | - Fernando Rivadeneira
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Carolina Medina-Gomez
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
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25
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Investigation of the Lower Extremity Fractures in Children Who Applied to the Emergency Department of University Hospital. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/gopctd.503015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Segal D, Slevin O, Aliev E, Borisov O, Khateeb B, Faour A, Palmanovich E, Brin YS, Weigl D. Trends in the seasonal variation of paediatric fractures. J Child Orthop 2018; 12:614-621. [PMID: 30607209 PMCID: PMC6293327 DOI: 10.1302/1863-2548.12.180114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The incidence of paediatric fractures is known to peak during the summer as a consequence of unsupervised physical activity. A more sedentary lifestyle is a potential cause for changes in paediatric seasonal fracture frequency and severity. The aim of this study was to evaluate the current seasonal variations of paediatric fractures in order to determine resource allocation in hospitals, community clinics and prevention programs. METHODS A single institutional review of historical data of all patients aged 0 to 16 years that were diagnosed with fractures between April 2014 and July 2017 in the emergency department of a level 3 orthopaedic trauma centre was conducted. In all, 3484 fractures were reviewed, of which 2991 were included. We stratified fractures according to patients' variants and the hour, day and month with respect to holidays, weekends and weather. RESULTS While the fracture rate on school days was 6.62 per day, the fracture rate during the summer vacation was 4.45 (p < 0.01). Hot weather was correlated with low fracture rates. The peak hours of admission were 12:00 to 13:00 and 18:00 to 22:00, with more moderate differences during non-school periods. CONCLUSION The local seasonal variation of paediatric fractures has a bimodal distribution, with similar nadirs during both summer and winter. These rates might reflect a shift to a more sedentary lifestyle during the summer vacation. The presented data can assist in improving the value of injury prevention measures and medical resources allocation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- D. Segal
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel, Correspondence should be sent to David Segal, Department of Orthopaedic Surgery, Meir Medical Center, 59 Tshernichovsky St., Kfar Saba, 4428164Israel. E-mail:
| | - O. Slevin
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - E. Aliev
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - O. Borisov
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - B. Khateeb
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - A. Faour
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - E. Palmanovich
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Y. S. Brin
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - D. Weigl
- Department of Orthopaedic Surgery, Schneider’s Children’s Hospital, Rabin Medical Center, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
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27
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Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015). Arch Osteoporos 2018; 13:63. [PMID: 29860609 DOI: 10.1007/s11657-018-0478-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/15/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend. PURPOSE Fracture incidence in 0-16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data. METHODS A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed. RESULTS Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred. CONCLUSIONS Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.
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Christoffersen T, Emaus N, Dennison E, Furberg AS, Gracia-Marco L, Grimnes G, Nilsen OA, Vlachopoulos D, Winther A, Ahmed LA. The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures. Osteoporos Int 2018; 29:441-450. [PMID: 29147750 PMCID: PMC6124640 DOI: 10.1007/s00198-017-4300-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed. PURPOSE Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels. METHODS We recruited 469 girls and 492 boys aged 15-18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm3). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA. RESULTS Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys. CONCLUSION Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.
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Affiliation(s)
- T Christoffersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway.
- Finnmark Hospital Trust, Alta, Norway.
| | - N Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton, UK
- Victoria University, Wellington, New Zealand
| | - A-S Furberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - L Gracia-Marco
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain
| | - G Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - O A Nilsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
| | - D Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - A Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
| | - L A Ahmed
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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Koga H, Omori G, Koga Y, Tanifuji O, Mochizuki T, Endo N. Increasing incidence of fracture and its sex difference in school children: 20 year longitudinal study based on school health statistic in Japan. J Orthop Sci 2018; 23:151-155. [PMID: 28947242 DOI: 10.1016/j.jos.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/05/2017] [Accepted: 09/06/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Studies on the epidemiology of pediatric fractures have been scarce in recent years although fractures are very common in childhood. Boys have a higher incidence of fractures than girls. Currently, societal trends have seemed to influence the difference in activity patterns between boys and girls, but the sex difference regarding longitudinal changes in fracture incidence is not well known. METHODS We analyzed the school accident report in Niigata city, Japan and compared the incidence of fractures in elementary and junior high school students and the sex-related risk ratio between two 9-year periods separated by 20 years from their start and end points (1999-2007 and 1979-1987). RESULTS The study included 383,273 students from 1999 to 2007 and 561,109 students from 1979 to 1987. Comparing these periods, the fracture incidence increased significantly by 2.4 times in boys vs 2.1 times in girls from elementary school and by 2.2 times in boys vs 2.9 times in girls from junior high school (all p < 0.001). The sex-related risk ratio of boys to girls increased significantly from 1.47 to 1.64 in elementary school students. In contrast, it decreased significantly from 3.29 to 2.52 in junior high school students and the change was markedly significant because of the drastic increase in fracture incidence in junior high school girls. CONCLUSIONS The reasons proposed for the increase in schoolchildren's fractures were an improvement in diagnosis owing to social background and increased participation in sports activities despite the general decline in children's physical fitness and exercise ability. In junior high school girls, in particular, there was an increase in fracture risk due to increased participation in sports activities.
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Affiliation(s)
- Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan.
| | | | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Lempesis V, Rosengren BE, Nilsson JÅ, Landin L, Johan Tiderius C, Karlsson MK. Time trends in pediatric fracture incidence in Sweden during the period 1950-2006. Acta Orthop 2017; 88:440-445. [PMID: 28562146 PMCID: PMC5499338 DOI: 10.1080/17453674.2017.1334284] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Pediatric fracture incidence may not be stable. We describe recent pediatric fracture epidemiology and etiology and compare this to earlier data. Patients and methods - The city of Malmö (population 271,271 in 2005) in Sweden is served by 1 hospital. Using the hospital diagnosis registry, medical charts, and the radiographic archive, we identified fractures in individuals <16 years that had occurred during 2005 and 2006. We also retrieved previously collected fracture data from between 1950 and 1994, from the hospital's pediatric fracture database. We used official population data to estimate period-specific fracture incidence (the number of fractures per 105 person-years) and also age- and sex-adjusted incidence. Differences are reported as rate ratios (RRs) with 95% confidence intervals. Results - The pediatric fracture incidence during the period 2005-2006 was 1,832 per 105 person-years (2,359 in boys and 1,276 in girls), with an age-adjusted boy-to-girl ratio of 1.8 (1.6-2.1). Compared to the period 1993-1994, age-adjusted rates were unchanged (RR =0.9, 95% CI: 0.8-1.03) in 2005-2006, with lower rates in girls (RR =0.8, 95% CI: 0.7-0.99) but not in boys (RR =1.0, 95% CI: 0.9-1.1). We also found that the previously reported decrease in unadjusted incidence in Malmö from 1976-1979 to 1993-1994 was based on changes in demography, as the age-adjusted incidences were similar in the 2 periods (RR =1.0, 95% CI: 0.9-1.1). Interpretation - In Malmö, pediatric fracture incidence decreased from 1993-1994 to 2005-2006 in girls but not in boys. Changes in demography, and also other factors, influence the recent time trends.
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Christoffersen T, Ahmed LA, Winther A, Nilsen OA, Furberg AS, Grimnes G, Dennison E, Center JR, Eisman JA, Emaus N. Fracture incidence rates in Norwegian children, The Tromsø Study, Fit Futures. Arch Osteoporos 2016; 11:40. [PMID: 27933566 DOI: 10.1007/s11657-016-0294-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study describes childhood fracture rates in Norway, a country known for high fracture rates in the adult population. Fracture rates correspond with other reports from Scandinavia, although with a slightly higher proportion in girls. Indications of increased vulnerability during stages of puberty require further exploration. INTRODUCTION Fractures are common injuries during childhood. Incidence rates and patterns vary, but population-based data are scarce. The aim of this study was to describe the sex-, age- and maturation-specific incidence of fractures in a representative population-based sample from a region in Norway. METHODS All fractures in the population based convenient cohort Fit Futures, comprising 961 adolescents under 18 years, were recorded retrospectively from the local hospital. Details on individual's age and fracture site were recorded. A radiologist confirmed all fractures. RESULTS In the period from birth to cohort scanning, the register recorded 316 fractures in 253 individuals. Fractures were more common in boys (35%) than in girls (31%). The overall annual fracture incidence was 204 per 10,000 persons-year under the age of 18 and 205 under the age of 16. The majority of fractures involved the upper extremities and the most common site of fracture was the forearm with 24% of the fractures followed by phalanges with 23% of the fractures. Fractures peaked in girls at sexual maturation stage 3. Boys had a peak in stage 2. Timing of subsequent fractures was also consistent with stages of sexual maturation. CONCLUSIONS The overall incidence of fractures in childhood in Northern Norway corresponds with other reports from Scandinavia, although the proportion of fractures in girls is higher than in other studies. Both sexes seem especially vulnerable at stages related to sexual maturation. Whether this reflects bone vulnerability or other changes related to puberty requires further investigation.
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Affiliation(s)
- Tore Christoffersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,Finnmark Hospital Trust, Alta, Norway.
| | - Luai A Ahmed
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Anne Winther
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
| | - Ole Andreas Nilsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne-Sofie Furberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Guri Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.,Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Southampton, UK.,Victoria University, Wellington, New Zealand
| | - Jacqueline R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.,St. Vincent's Clinical School, UNSW, Sydney, Australia.,Department of Endocrinology, St. Vincent's Hospital, Sydney, Australia
| | - John A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.,School of Medicine Sydney, The University of Notre Dame Australia, Fremantle, Australia.,St. Vincent's Clinical School, UNSW, Sydney, Australia.,Department of Endocrinology, St. Vincent's Hospital, Sydney, Australia
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Randsborg PH, Røtterud JH. No difference in the level of physical activity between children who have or have never sustained a fracture. Scand J Med Sci Sports 2016; 27:1801-1805. [PMID: 27739115 DOI: 10.1111/sms.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/30/2022]
Abstract
This study investigates whether children with an acute fracture have a different level of physical activity compared to children who have never sustained a fracture, as measured by the Physical Activity Questionnaire for older children (PAQ-C). The PAQ-C scores of 683 children (295 girls) aged 6-12 years (mean age 9.4 years) who presented to our institution with an acute fracture were compared to the PAQ-C scores of 151 random children (81 girls) aged 6-12 years (mean 9.1 years) in the same area who had never sustained a fracture. Multivariate regression analysis was employed, controlling for age and gender. The mean PAQ-C score of the children who presented to the institution with an acute fracture was 2.85 (95% confidence interval [CI], 2.80-2.91). For the children who had never sustained a fracture, the mean PAQ-C score was 2.78 (95% CI, 2.69-2.87). If there is a true difference in the level of physical activity between children who have or have never sustained a fracture, the PAQ-C questionnaire is not sensitive enough to identify it.
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Affiliation(s)
- P-H Randsborg
- The Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - J H Røtterud
- The Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
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Jerrhag D, Englund M, Petersson I, Lempesis V, Landin L, Karlsson MK, Rosengren BE. Increasing wrist fracture rates in children may have major implications for future adult fracture burden. Acta Orthop 2016; 87:296-300. [PMID: 26905618 PMCID: PMC4900094 DOI: 10.3109/17453674.2016.1152855] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skåne in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged ≤ 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period 1999-2010, the distal forearm fracture rate was 634 per 10(5) patient years (750 in boys and 512 in girls). This was 50% higher than in the 1950s with a different age-rate distribution (p < 0.001) that was most evident during puberty. Also, within the period 1999-2010, there were increasing fracture rates per 10(5) and year (boys +2.0% (95% CI: 1.5-2.6), girls +2.4% (95% CI: 1.7-3.1)). Interpretation - The distal forearm fracture rate in children is currently 50% higher than in the 1950s, and it still appears to be increasing. If this higher fracture risk follows the children into old age, numbers of fragility fractures may increase sharply-as an upturn in life expectancy has also been predicted. The origin of the increase remains unknown, but it may be associated with a more sedentary lifestyle or with changes in risk behavior.
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Affiliation(s)
- Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,,Correspondence:
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Ingmar Petersson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Bjorn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
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Moon RJ, Harvey NC, Curtis EM, de Vries F, van Staa T, Cooper C. Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom. Bone 2016; 85:9-14. [PMID: 26802259 PMCID: PMC4841386 DOI: 10.1016/j.bone.2016.01.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fractures are common in childhood, and there is considerable variation in the reported incidence across European countries, but few data relating to ethnic and geographic differences within a single country. We therefore aimed to determine the incidence of childhood fractures in the United Kingdom (UK), and to describe age-, ethnicity- and region- specific variations. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 7% of the UK population. The occurrence of a fracture between 1988 and 2012 was determined from the CPRD for all individuals <18years of age, and used to calculate fracture incidence rates for age, sex and ethnicity. Regional fracture incidence rates were also calculated based on general practitioner location within 14 Strategic Health Authorities (SHA) within the UK. RESULTS The overall fracture incidence rate was 137 per 10,000 person-years (py). This was higher in boys (169 per 10,000 py) than girls (103 per 10,000 py) and white children (150 per 10,000 py) compared to those of black (64 per 10,000 py) and South Asian (81 per 10,000 py) ethnicity. Marked geographic variation in incidence was observed. The highest fracture rates were observed in Wales, where boys and girls had 1.82 and 1.97 times greater incidence, respectively, than those residing in Greater London. CONCLUSION In the period 1988-2012, there was marked geographic and ethnic variation in childhood fracture incidence across the UK. These findings also implicate lifestyle and socio-economic differences associated with location and ethnicity, and are relevant to policy makers in the UK and internationally.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth, Road, M13 9PL, UK; Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508, TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
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Fritz J, Cöster ME, Nilsson JÅ, Rosengren BE, Dencker M, Karlsson MK. The associations of physical activity with fracture risk--a 7-year prospective controlled intervention study in 3534 children. Osteoporos Int 2016; 27:915-922. [PMID: 26359184 DOI: 10.1007/s00198-015-3311-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/01/2015] [Indexed: 01/23/2023]
Abstract
SUMMARY This is the first study indicating an association between gradually diminished risk of fractures and years of increased physical activity. Our results could imply great benefits not only for the individual but also for the healthcare burden and cost of society. INTRODUCTION Physical activity (PA) in childhood is associated with high bone mass and beneficial neuromuscular function. We investigate if increased PA also is associated with fracture risk. METHODS We registered fractures in 3534 children aged 6 to 8 years at study start for up to 7 years; 1339 with 40 min of moderate PA every school day (intervention) and 2195 with the Swedish standard curriculum of 60 min of PA per school week (controls). In a subsample of 264 children, we measured areal bone mineral density (aBMD; g/cm(2)) with dual-energy X-ray absorptiometry (femoral neck and total spine) and muscle strength (peak torque for knee extension and flexion; Nm) with computerized dynamometer at baseline and after 7 years. We estimated annual fracture incidence rate ratios (IRR) in the intervention group compared to the control group as well as changes in bone mass and muscle strength. Data is given as mean (95% CI). RESULTS The IRR of fractures decreased with each year of the PA intervention (r = -0.79; p = 0.04). During the seventh year, IRR was almost halved [IRR 0.52 (0.27, 1.01)]. The intervention group had a statistically significant greater gain in total spine aBMD with a mean group difference of 0.03 (0.00, 0.05) g/cm(2) and peak flexion torque 180° with a mean group difference of 5.0 (1.5, 8.6) Nm. CONCLUSIONS Increased PA is associated with decreased fracture risk, probably in part due to beneficial gains in aBMD and muscle strength.
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Affiliation(s)
- J Fritz
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - M E Cöster
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - J-Å Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - B E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - M Dencker
- Department of Physiology and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Händel MN, Heitmann BL, Abrahamsen B. Nutrient and food intakes in early life and risk of childhood fractures: a systematic review and meta-analysis. Am J Clin Nutr 2015; 102:1182-95. [PMID: 26447151 DOI: 10.3945/ajcn.115.108456] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The identification of detrimental dietary patterns early in life may contribute to reducing the high incidence of fracture among healthy children. However, information based on a systematic review of the effect of various dietary foods and nutrients on fracture risk is lacking. OBJECTIVE We conducted a systematic review and meta-analysis of observational studies that examined the association between dietary intake or serum nutritional concentrations and childhood fractures. DESIGN Studies published up until June 2015 were identified on the basis of a literature search in Medline, Web of Science, and Scopus databases and by hand searching references by first author based on predefined inclusion criteria. A meta-analysis was carried out for case-control studies that examined differences in mean calcium intake in the case compared with the control group. Random-effects analysis was performed on the basis of the effect estimates derived as the differences in mean calcium intakes between cases and controls. RESULTS From a total of 1960 articles, we identified 18 observational studies, which were primarily case-control in design. Randomized controlled trials were absent, potentially because of unethical aspects related to the enrollment of children randomly assigned to certain dietary exposures and later fracture rates. Overall, fracture risk seemed to be associated with milk avoidance, high energy intake, high cheese intake, high intake of sugar-sweetened beverages, and no breastfeeding. The pooled effect size of the 9 case-control studies that examined mean calcium intake, which had appropriate data for the meta-analysis, showed no association (P = 0.99) with fair heterogeneity (I(2) = 69.3%, P = 0.001) with the use of the random-effects model. CONCLUSIONS On the basis of a systematic review of studies that were judged to be of high or medium quality, there is an indication that some nutritional factors seem to be associated with an increased fracture risk among children. The results may be inflated by selection bias, bias in diet reporting, or residual confounding. More high-quality longitudinal observational or intervention studies are needed on the subject.
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Affiliation(s)
- Mina N Händel
- Research Unit for Dietary Studies, Institute of Preventive Medicine and the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; Institute of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark;
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine and the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, University of Sydney, Sydney, Australia; and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bo Abrahamsen
- Institute of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark; Department of Medicine, Holbæk Hospital, Holbæk, Denmark
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Issin A, Kockara N, Oner A, Sahin V. Epidemiologic Properties of Pediatric Fractures in a Metropolitan Area of Turkey. Medicine (Baltimore) 2015; 94:e1877. [PMID: 26512602 PMCID: PMC4985416 DOI: 10.1097/md.0000000000001877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Occurrence of fractures is highly dependent on lifestyle. Domestic data should be used when needed. In this cross-sectional study, the authors aim to find the most recent distribution of pediatric fracture types and the attributes of fracture occurrence within a large sample size in a metropolitan area of Turkey.This study consists of 4879 pediatric age patients with a fracture who took advantage of the emergency service of a trauma center in a metropolitan area between March 2010 and December 2013 (1397 days). Date, hour, age, sex, fracture type, and social security status of the patients were studied.A total of 65% of the patients were men and 35% were women. A total of 81% of the fractures were in the upper extremities, whereas 19% of them were in the lower extremities. In 22 patients (0.5%), there were open fractures. Fractures showed some seasonal, daily, and circadian variations. Different types of fractures showed some specific patterns in different age groups. Ankle, elbow, and shoulder fractures were more common in girls, whereas wrist and forearm fractures were more in boys and the difference was statistically significant (P < 0.05).Fractures in pediatric ages vary depending on the age, sex, season, and the hour of the day. Types of fractures show some obvious patterns especially depending on the age. This data can be useful in making optimizations in fracture care units. Considering these specific patterns would enable more effective planning of providing preventive measures for pediatric injuries.
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Affiliation(s)
- Ahmet Issin
- From the Mengucek Gazi Education and Research Hospital Orthopedics and Traumatology Department, Erzincan University, Erzincan (AI, NK); Orthopedics and Traumatology Department, Metin Sabanci Bone and Joint Diseases Education and Research Hospital, Istanbul (AO); and Mengucek Gazi Education and Research Hospital Orthopedics and Traumatology Department, Erzincan University, Erzincan, Turkey (VS)
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Mehrpour SR, Nabian MH, Oryadi Zanjani L, Foroughmand-Araabi MH, Shahryar Kamrani R. Descriptive epidemiology of traumatic injuries in 18890 adults: a 5-year-study in a tertiary trauma center in iran. Asian J Sports Med 2015; 6:e23129. [PMID: 25883772 PMCID: PMC4393542 DOI: 10.5812/asjsm.23129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/14/2014] [Accepted: 12/02/2014] [Indexed: 11/22/2022] Open
Abstract
Background: Basic epidemiological data can provide estimates when discussing disease burden and in the planning and provision of healthcare strategies. There is little quantitative information in the literature regarding prevalence of traumatic injuries from developing countries. Objectives: The aim of the current preliminary study was to reveal the prevalence and age and gender distribution of various traumatic injuries in a tertiary referral orthopedic hospital in Iran. Patients and Methods: In a prospective descriptive study, all traumatic injured patients attending the Orthopedic Trauma Unit of our center in a five year period were included. Demographic details, the cause of injury, injury classification and treatment were recorded. For each of the five-year age groups and each gender we calculated the numbers with fractures, dislocations, soft tissue injuries, ligamentous injuries and lacerations and derived average age and gender-specific prevalence as well as seasonal variations. Results: A total of 18890 adults were admitted, 13870 (73.4%) males and 5020 (26.6%) females. There were 8204 (43.4%) fractures. The male fracture age distribution curve was unimodal and there was a detectable bimodal pattern in females. Under 65 years males are 3 times more likely to sustain a fracture than females which decreases to equal risk over the age of 65. The most common fracture site was distal radius/ulna (13.8%), followed by tibial diaphysis (8.8%), proximal femur (7.8%), finger phalanges (6.4%), metacarpals (6%) and metatarsals (5.9%). There were seasonal variations in fracture incidence with peaks in February, March and October. The least number of fractures occurred in June. Conclusions: The risk of traumatic injuries is higher among specific age groups with different patterns emerging for men and women. Thus, the descriptive epidemiology will provide useful information for treatment or injury prevention strategies, resource allocation, and training priorities.
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Affiliation(s)
- Saeed Reza Mehrpour
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Hossein Nabian, Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9126305095, E-mail:
| | - Leila Oryadi Zanjani
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Reza Shahryar Kamrani
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Abstract
Pubertal maturation plays a fundamental role in bone acquisition. In retrospective epidemiological surveys in pre- and postmenopausal women, relatively later menarcheal age was associated with low bone mineral mass and increased risk of osteoporotic fracture. This association was usually ascribed to shorter time exposure to estrogen from the onset of pubertal maturation to peak bone mass attainment. Recent prospective studies in healthy children and adolescents do not corroborate the limited estrogen exposure hypothesis. In prepubertal girls who will experience later menarche, a reduced bone mineral density was observed before the onset of pubertal maturation, with no further accumulated deficit until peak bone mass attainment. In young adulthood, later menarche is associated with impaired microstructural bone components and reduced mechanical resistance. This intrinsic bone deficit can explain the fact that later menarche increases fracture risk during childhood and adolescence. In healthy individuals, both pubertal timing and bone development share several similar characteristics including wide physiological variability and strong effect of heritable factors but moderate influence of environmental determinants such as nutrition and physical activity. Several conditions modify pubertal timing and bone acquisition, a certain number of them acting in concert on both traits. Taken together, these facts should prompt the search for common genetic regulators of pubertal timing and bone acquisition. It should also open epigenetic investigation avenues to pinpoint which environmental exposure in fetal and infancy life, such as vitamin D, calcium, and/or protein supplies, influences both pubertal timing and bone acquisition.
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Affiliation(s)
- Jean-Philippe Bonjour
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland
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Abstract
OBJECTIVE Hand fractures represent a leading cause of morbidity in children. However, little information exists correlating the mechanisms and environment of injury with outcomes and treatments. We examine the demographics, etiology, anatomic location, mechanism, and management of pediatric hand fractures in our center's hand unit. METHODS We conducted a prospective observational study on all children with acute hand fractures evaluated in the Plastic Surgery Emergency Clinic during a 3-month period in 2010. Data pertaining to demographics, referral patterns, injury pattern, clinical outcomes, and other factors related to hand fractures were then analyzed and interpreted. RESULTS Most children were referred by our institution's emergency department. More than 60% were boys, and nearly half were between 10 and 15 years old. The right and left hands were injured at equal rates. Most of the injuries (90%) occurred in the afternoon or evening. More than 85% occurred in urban, rather than rural, environments. Crush injuries were the leading cause in toddlers, whereas sports-related injuries became the major cause of injury in older groups. Proximal phalanges were the most common bone injured, and the fifth digit was the most commonly injured digit. More than 80% of the fractures were managed nonsurgically. CONCLUSIONS The pattern of pediatric hand fracture in different age groups is highlighted in this article. The observations from this study will hopefully encourage further review with a larger cohort and a focus on preventative measures for pediatric hand fractures.
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Dodd A, Paolucci EO, Parsons D. Paediatric femoral shaft fractures: what are the concomitant injuries? Injury 2013; 44:1502-6. [PMID: 23481316 DOI: 10.1016/j.injury.2013.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 12/30/2012] [Accepted: 02/07/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma remains a substantial cause of paediatric morbidity and mortality. Femur fractures are common in children, and frequently are the result of high-energy mechanisms of injury. A complete description of missed injuries in this population has not previously been described. MATERIALS AND METHODS A retrospective chart review of patients presenting to the Alberta Children's Hospital with femoral shaft fractures was performed. Associated injuries, and injuries with delayed diagnosis were recorded. RESULTS Twenty-percent of the patients suffered at least one other injury with their femur fracture. Six-percent of injuries had a delayed diagnosis, corresponding to three-percent of the patients reviewed. CONCLUSION There is a risk of missed injuries in the paediatric patient presenting with a femoral shaft fracture. Paediatric trauma teams and paediatric orthopaedic teams must be aware of this risk to help reduce the incidence of missed injuries. A tertiary trauma survey on children with paediatric femoral shaft fractures may help diagnose missed injuries.
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Affiliation(s)
- Andrew Dodd
- Orthopedic Surgery Residency Training Program, University of Calgary, Canada.
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Uddenfeldt Wort U, Nordmark E, Wagner P, Düppe H, Westbom L. Fractures in children with cerebral palsy: a total population study. Dev Med Child Neurol 2013; 55:821-6. [PMID: 23750743 DOI: 10.1111/dmcn.12178] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 11/29/2022]
Abstract
AIM To analyse factors associated with fractures in children with cerebral palsy (CP) in different levels of Gross Motor Function Classification System (GMFCS). METHOD This was an epidemiological retrospective study of a total population of 536 children (214 females, 322 males) with CP born between 1990 and 2005. CP type was unilateral spastic (n=159), bilateral spastic (n=225), ataxic (n=60), dyskinetic (n=80), and mixed type (n=12); 384 children were in Gross Motor Function Classification Scale (GMFCS) levels I-III and 152 children were in GMFCS levels IV-V. Data were collected for a 9-year period on sex, CP-type, GMFCS level, gastrostomy, height, weight, the use of a standing device, antiepileptic drug (AED) therapy, and fractures. RESULTS The risk of fracture in the total population of children with CP was similar to that for typically developing children. The risk for fractures of those in GMFCS levels I-III was not significantly associated with any of the studied risk factors. The risk of fractures for those in GMFCS levels IV-V on AED therapy was a twofold increase (p=0.004). The risk for fractures without trauma in children with stunted growth (height for age <-3 SD) and those who did not use standing devices was significantly increased: adjusted incidence rate ratio (AIRR) 4.16 (p=0.011) and 3.66 (p=0.010) respectively. Results regarding gastrostomy feeding for those in GMFCS levels IV-V were conflicting: a gastrostomy was associated with a reduced risk of fractures with trauma, but with increased risk of fractures without trauma (AIRR 0.10, p=0.003 and 4.36, p=0.012) respectively. INTERPRETATION Children in GMFCS levels I-III had a similar incidence and pattern for fractures as normally developing children. Those in GMFCS levels IV-V had stunted growth, often a sign of longstanding undernourishment, and were associated with an increased risk of fractures. Children using standing devices had a fourfold reduction of fractures without trauma. Regular loading exercises and early adequate nutritional intake could prevent fractures in severe CP.
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Affiliation(s)
- Ulrika Uddenfeldt Wort
- Department of Clinical Sciences (Malmö), Social Medicine and Global Health, Lund University, Malmö, Sweden.
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Randsborg PH, Gulbrandsen P, Saltytė Benth J, Sivertsen EA, Hammer OL, Fuglesang HFS, Arøen A. Fractures in children: epidemiology and activity-specific fracture rates. J Bone Joint Surg Am 2013; 95:e42. [PMID: 23553305 DOI: 10.2106/jbjs.l.00369] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately one-third of pediatric fractures occur during sport or recreational activity. In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities. METHODS We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period. Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population. The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities. RESULTS A total of 1403 fractures were included. The overall annual incidence was 180.1 fractures per 10,000 children younger than sixteen years. The distal part of the radius was most often fractured (436 fractures, 31.1%). Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 1.9 (95% confidence interval [CI], 1.16 to 2.60) fractures per 10,000 hours of exposure. In comparison, the fracture rate per 10,000 hours of exposure was 0.79 (CI, 0.42 to 1.09) for handball, 0.44 (CI, 0.35 to 0.52) for soccer, and 0.35 (CI, 0.23 to 0.47) for trampolining. CONCLUSIONS The distal part of the radius is the most common fracture site in childhood. Fracture rates differ between various physical activities. The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, NO-1478 Lørenskog, Norway.
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Martin DD, Heckmann C, Neuhof J, Jenni OG, Ranke MB, Binder G. Comparison of radiogrammetrical metacarpal indices in children and reference data from the First Zurich Longitudinal Study. Pediatr Radiol 2012; 42:982-91. [PMID: 22669456 PMCID: PMC3414699 DOI: 10.1007/s00247-012-2390-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/17/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND A number of radiogrammetrical metacarpal indices are in use, some of which have been adapted for children. OBJECTIVE The purpose of this study was to compare four known indices-bone mineral density (BMD), relative cortical area, Exton-Smith index, bending breaking resistance index-and the more recently defined pediatric bone index (PBI) according to the two criteria of minimum height dependence and minimum variability in children of equal bone age. MATERIALS AND METHODS A total of 3,121 left-hand radiographs from 231 healthy Caucasian children ranging in age from 3 to 19 years old were analysed using BoneXpert®, a programme for automatic analysis of hand radiographs and assessment of bone age. RESULTS Dependence on height for chronological age or bone age and the mean relative standard deviation were lowest in the PBI for both genders pooled. The differences in height dependence were statistically significant and are shown to be clinically relevant. Reference data for PBI are presented. CONCLUSION PBI may be a better indicator than BMD for bone health in children; however, verification in a clinical group is needed.
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Affiliation(s)
- David D Martin
- Pediatric Endocrinology and Diabetology, University Children's Hospital Tübingen, Hoppe-Seyler-Str 1, 72076 Tuebingen, Germany.
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Slaar A, Bentohami A, Kessels J, Bijlsma TS, van Dijkman BA, Maas M, Wilde JCH, Goslings JC, Schep NWL. The role of plain radiography in paediatric wrist trauma. Insights Imaging 2012; 3:513-7. [PMID: 22733622 PMCID: PMC3443275 DOI: 10.1007/s13244-012-0181-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/28/2012] [Accepted: 06/04/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Acute wrist trauma in children is one of the most frequent reasons for visiting the emergency department (ED). Radiographic imaging in children with wrist trauma is mostly performed routinely to confirm or rule out a fracture. The aim of this study was to determine how many radiographs of the wrist show a fracture in children following wrist trauma. METHODS A retrospective cohort study was performed in three Dutch hospitals from 2009-2010. Data were extracted from patient records and radiographic reports. RESULTS Of the 1,223 children who presented at the ED after a wrist trauma, 51 % had a wrist fracture. The peak incidence of having a wrist fracture was at the age of 10 years; 65 % of the children younger than 10 years of age had a wrist fracture. Of all the patients without a wrist fracture, 74 % were older than 10 years of age. CONCLUSION Almost half of the paediatric patients with a trauma of the wrist had normal radiographs. The development of a clinical decision rule to determine when a radiograph of the wrist is indicated following acute wrist trauma is needed. This could likely reduce the number of radiographs. MAIN MESSAGES • Fifty-one percent of the children with wrist trauma have a wrist fracture. • Peak incidence of having a wrist fracture is at the age of 10 years. • Sixty-five percent of the children younger than 10 years of age had a wrist fracture. • Of all the patients without a wrist fracture, 74 % were older than 10 years of age. • The development of a clinical decision rule to reduce the number of radiographs is needed.
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Affiliation(s)
- Annelie Slaar
- Department of Radiology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Mäyränpää MK, Viljakainen HT, Toiviainen-Salo S, Kallio PE, Mäkitie O. Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: a case-control study. J Bone Miner Res 2012; 27:1413-24. [PMID: 22367922 DOI: 10.1002/jbmr.1579] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Frequent fractures in children may be a sign of impaired bone health, but it remains unestablished when and how fracture-prone children should be assessed. This prospective study elucidated skeletal characteristics and predisposing factors in children with recurrent fractures. Findings were used to establish guidelines for screening. During a 12-month period we recorded fracture history for all children (n = 1412) treated for an acute fracture at a large university hospital. All apparently healthy children over 4 years of age, who had sustained: (1) at least one vertebral fracture; (2) two long-bone fractures before age 10 years; or (3) three long-bone fractures before age 16 years, were recruited. They underwent dual-energy X-ray absorptiometry (DXA), laboratory tests, and spinal radiography. Information regarding family history and lifestyle factors were collected. Findings were compared with healthy controls. Sixty-six fracture-prone children (44 males, mean age 10.7 years; 5% of all children with fractures) were identified. Altogether, they had sustained 183 long-bone fractures (median 3, range 0–7); 11 children had sustained vertebral fracture(s). Patients had significantly lower bone mineral density (BMD) at lumbar spine (p < 0.001), hip (p = 0.007), and whole body (p < 0.001) than the controls; only 5 children (8%) had a BMD Z-score < −2.0. Asymptomatic vertebral compressions were prevalent, especially in those under 10 years of age. Hypercalciuria (11%) and hyperphosphaturia (22%) were significantly more prevalent than in controls. Serum concentration of 25-hydroxyvitamin D (S-25OHD) was below 50 nmol/L in 55%; low levels were associated with low BMD and vertebral compressions. The fracture-prone children had lower calcium intake, less physical activity, and more often had siblings with fractures than the controls. The findings suggest that a thorough pediatric evaluation, including DXA and spinal radiography, is often indicated already after a second significant low-energy fracture in children, in order to detect potentially preventable adverse lifestyle factors and nutritional deficits and to identify those with compromised overall bone health.
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Affiliation(s)
- Mervi K Mäyränpää
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Stenbäckinkatu 11, HUS, Helsinki, Finland.
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Tyflidis A, Kipreos G, Tripolitsioti A, Stergioulas A. Epidemiology of school fractures: a 1-year experience in Greek facilitation classes. JOURNAL OF HUMAN SPORT AND EXERCISE 2012. [DOI: 10.4100/jhse.2012.72.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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de Putter CE, van Beeck EF, Looman CWN, Toet H, Hovius SER, Selles RW. Trends in wrist fractures in children and adolescents, 1997-2009. J Hand Surg Am 2011; 36:1810-1815.e2. [PMID: 22036281 DOI: 10.1016/j.jhsa.2011.08.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/02/2011] [Accepted: 08/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. METHODS We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. RESULTS During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. CONCLUSIONS This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. CLINICAL RELEVANCE With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.
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Affiliation(s)
- C E de Putter
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC Rotterdam, Rotterdam.
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