Fractures in Children: Epidemiology and Activity-Specific Fracture Rates

Randsborg, Per-Henrik; Gulbrandsen, Pål; Benth, Jūratė Šaltytė; Sivertsen, Einar Andreas; Hammer, Ola-Lars; Fuglesang, Hendrik F. S.; Årøen, Asbjørn

doi:10.2106/jbjs.l.00369

Cited by 142 publications

(109 citation statements)

References 33 publications

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“…That said, this study may not apply to places with significantly different climates or where all four seasons are not represented. This study has confirmed that weather and temporal phenomena do indeed affect the workload of the pediatric orthopedic trauma service, which is not surprising considering previous studies have found that over 1/3 of pediatric fractures occur during sport and recreational activity and 71% occur outdoors [3, 13, 14]. However, the results and associations of our study may not be generalizable to other settings due to climate variability, and this is a limitation of this study.…”

Section: Discussionsupporting

confidence: 73%

Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume

Livingston

Miller

Lierhaus

et al. 2016

TOORTHJ

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Objectives:Orthopaedists often speculate how weather and school schedule may influence pediatric orthopedic trauma volume, but few studies have examined this. This study aims to determine: how do weather patterns, day, month, season and public school schedule influence the daily frequency of pediatric orthopedic trauma consults and admissions?Methods:With IRB approval, orthopedic trauma data from a level 1 pediatric trauma center, including number of daily orthopedic trauma consults and admissions, were collected from July 2009 to March 2012. Historical weather data (high temperatures, precipitation and hours of daylight), along with local public school schedule data were collected for the same time period. Univariate and multivariate regression models were used to show the average number of orthopedic trauma consults and admissions as a function of weather and temporal variables.Results:High temperature, precipitation, month and day of the week significantly affected the number of daily consults and admissions. The number of consults and admissions increased by 1% for each degree increase in temperature (p=0.001 and p<0.001, respectively), and decreased by 21% for each inch of precipitation (p<0.001, p=0.006). Daily consults on snowy days decreased by an additional 16% compared to days with no precipitation. November had the lowest daily consult and admission rate, while September had the highest. Daily consult rate was lowest on Wednesdays and highest on Saturdays. Holiday schedule was not independently significant.Conclusion:Pediatric orthopedic trauma consultations and admissions are highly linked to temperature and precipitation, as well as day of the week and time of year.

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Section: Discussionsupporting

confidence: 73%

Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume

Livingston

Miller

Lierhaus

et al. 2016

TOORTHJ

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“…to 30% of all fractures in children. 16,17 On the basis of epidemiologic estimates for children younger than 10 years, the incidence of these fractures has been increasing over time, and they are estimated to represent approximately 280 000 ED visits yearly. 1,[17][18][19][20][21][22][23] In With reported rates of redisplacement from 20% to 30% despite anatomic manipulation at presentation, reinforcing remodeling potential alone for these fractures may avoid what is often a temporary reduction and may eliminate the need to closely monitor redisplacement to initial deformity.…”

Section: Discussionmentioning

confidence: 99%

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

et al. 2020

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IMPORTANCE Improvement of clinician understanding of acceptable deformity in pediatric distal radius fractures is needed. OBJECTIVE To assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture and the associated cost implications for these reduction procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included 258 consecutive children younger than 10 years who presented to a single, level I, pediatric emergency department and who had a distal radius fracture with or without ulna involvement between January 1, 2016, and December 31, 2017. Reductions were deemed to be potentially unnecessary if the coronal and sagittal plane angulation of the radius bone measured less than 20°and shortening measured less than 1 cm on initial injury radiographs. Use of procedural sedation or transfer status to another facility was noted if present. Statistical analysis was performed from April 2019 to June 2019. MAIN OUTCOMES AND MEASURES Potentially unnecessary reduction was the primary outcome. Radiographic findings were measured to determine reduction necessity. Additional variables measured were age, sex, time in the emergency department, transfer status, required reduction procedure, use of sedation, and cost associated with care. RESULTS Of the 258 participants studied, 156 (60%) were male, with a mean (SD) age of 6.7 (2.3) years. Among 142 patients (55%) who underwent closed reduction with procedural sedation in the emergency department, 38 (27%) procedures were determined to be potentially unnecessary. Review of Common Procedural Terminology charges revealed an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department vs a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6°(10.3°) compared with 13.9°(4.5°) for those unnecessarily reduced (P < .001). Patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction (odds ratio, 2.3; 95% CI, 1.1-5.0; P = .03). CONCLUSIONS AND RELEVANCE The findings suggest that improved awareness of these acceptable deformities in young children may be associated with limiting the number of children requiring reduction with sedation, improving emergency department efficiency, and substantially reducing health care costs.

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“…In Norway, in a prospective 12-month study of children 0–16 years of age in 2010–2011, Randsborg et al. ( 2013 ) found an overall incidence of distal radius fractures of 560 per 10 5 . The method included evaluation of radiographs and medical charts.…”

Section: Discussionmentioning

confidence: 99%

Increasing wrist fracture rates in children may have major implications for future adult fracture burden

et al. 2016

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Background and purposeChildhood 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 methodsBy 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.ResultsDuring the period 1999–2010, the distal forearm fracture rate was 634 per 105 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 105 and year (boys +2.0% (95% CI: 1.5–2.6), girls +2.4% (95% CI: 1.7–3.1)).InterpretationThe 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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Fractures in Children: Epidemiology and Activity-Specific Fracture Rates

Abstract: 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.

Cited by 142 publications

References 33 publications

Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume

Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

Increasing wrist fracture rates in children may have major implications for future adult fracture burden

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