Childhood Femur Fractures, Associated Injuries, and Sociodemographic Risk Factors: A Population-Based Study

Abstract

ABSTRACT. Objective. The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors.Methods. The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively.Results. During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100 000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92-2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft ؉ distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In smallarea analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics. Conclusions

Independent risk factors for injury in pre-school children: three population-based nested case-control studies using routine primary care data

“…Few previous studies report fracture as an injury outcome but our findings with respect to child age are consistent with those that do, such as Flavin et al [38]. Our findings with respect to child sex are consistent with studies of thermal injuries and fractures [19,32,[47][48][49]. We did not find an association between sex and poisoning, which is consistent with data reported by Beautrais et al [20] and with the poisoning incidence statistics reported by the World Health Organisation, which showed only a small (0.1/100,000) difference in poisoning rates in Europe between boys and girls [2].…”

Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

“…All fracture patterns (transverse, spiral, and comminuted) can occur in abuse. Only 12% to 13% of femur shaft fractures are due to abuse in children younger than 3 years [4,19]. In children younger than 1 year, up to 30% of femur fractures are reportedly from abuse [12].…”

Long Bone Fractures

“…As mentioned earlier, Loder and Bookout [21] reviewed 75 cases of battered children with a total of 154 fractures and found the most common long bone fracture was transverse shaft fractures, followed by CMLs. Rewers et al [31] conducted a review of the cases with documented femoral fractures entered into the Colorado Trauma Register over a 4-year period. They found that among children younger than 3 years, falls were the most common cause of femoral fractures, followed by nonaccidental injury.…”