Elsevier

Injury

Volume 38, Issue 8, August 2007, Pages 913-922
Injury

The epidemiology of fractures in children

https://doi.org/10.1016/j.injury.2007.01.036Get rights and content

Summary

A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1 m) being the commonest cause of fracture.

The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.

Introduction

Injuries are common in childhood with studies showing that on average about 25% of children are injured each year.12, 11 It has been shown that fractures account for 10–25% of childhood injuries5 and that the effects of paediatric fractures are considerable with significant restriction of activity.3 Despite this the epidemiology of paediatric fractures is poorly understood. Landin4 documented the epidemiology of fractures in children in Malmö in Sweden and showed that the incidence of fractures almost doubled between the 1950s and the 1970s. However, there have been comparatively few studies since then and there has been recent debate12, 5, 7, 6 about the incidence of fractures in children. We analysed all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 to ascertain their incidence, demonstrate which fractures were most common and investigate the causes of fracture in different age groups. We also set out to examine the fracture distribution curves of all fractures to see if there was a reproducible set of curves, which would encompass all fractures.

Section snippets

Materials and methods

A retrospective analysis of all paediatric fractures in the council areas of the city of Edinburgh, Midlothian and East Lothian in Scotland was undertaken. All in-patient and out-patient fractures in children aged less than 16 years of age were examined. These patients are all treated in two hospitals, the Royal Hospital for Sick Children in Edinburgh and the Royal Infirmary of Edinburgh. There are no other paediatric trauma units in the area.

Both hospitals keep prospective databases of all

Results

The population of patients in Edinburgh, Midlothian and East Lothian aged less than 16 years at the 2001 census was 108,987 with a gender ratio of 51:49% males to females. During the year 2000 there were 2198 fractures in 2168 patients. Twenty-seven patients (1.2%) presented with more than one fracture, 24 patients sustained 2 fractures and 3 patients had 4 fractures. The overall incidence was 20.2 fractures/1000/year and the overall average age was 9.7 years. Analysis of gender showed that

Discussion

Fractures in children show epidemiological characteristics, which are different from fractures in adults. A review of fractures in adult patients in Edinburgh in the year 2000 was also undertaken1 and the basic epidemiology is shown in Table 8. This shows that fractures in children have almost twice the incidence of fractures in adults. Equal numbers of male and female adults are affected but in children there is a strong male predominance. More adults present with multiple and open fractures.

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