Increased incidence of distal humeral fractures and surgical treatment in 0- to 18-year-old patients treated in Finland from 1987 to 2010

Abstract

Background Studies of pediatric and adolescent fractures in general report a significant increase in the incidence of upper-extremity fractures as well as in their surgical treatment. The aim of this study was to determine the trends of the incidence and treatment of distal humeral fractures in hospitalized 0-to 18-year-old patients in Finland. Method The study included the entire pediatric and adolescent (\19 years) population in Finland during the 24-year period from 1 January 1987 to 31 December 2010. Data on hospitalized patients were obtained from the nationwide National Hospital Discharge Registry where information is collected from all hospital categories (private, public, and other). Surgical treatment was categorized into three groups; (1) reposition with casting; (2) reposition or reduction and osteosynthesis; (3) reposition or reduction and external-fixation and other fixation methods. Patients were classified into three groups according to age: 0-6 years, 7-13 years, and 14-18 years. Annual incidences were calculated using the annual mid-year population census obtained from the Official Statistics of Finland. Results During the 24-year study period, there were a total of 12,590 hospitalizations with a main or secondary diagnosis of distal humeral fracture. In children aged 0-12 years the overall incidence of hospitalization increased 30 % during the 24-year study period, from 4.5 per 10,000 person-years in 1987 to 5.8 per 10,000 person-years in 2010. There were a total of 5,548 operations. During the study period, surgical treatment by repositioning or reduction with osteosynthesis due to a distal humeral fracture increased by fivefold in patients aged\6 years and by twofold in patients aged 7-12 years of age. The incidences of fracture and treatment in children older than 13 years did not change. Conclusion The incidence of distal humeral fractures and the incidence of repositioning with osteosynthesis increased remarkably in prepubertal children during the 24-year study period in Finland.

Gartland Type II Supracondylar Humerus Fractures, Their Operative Treatment and Lateral Pinning Are Increasing: A Population-Based Epidemiologic Study of Extension-Type Supracondylar Humerus Fractures in Children

“…13 A similar increase (30%) of distal humerus fractures was found in patients who were hospitalized between 1987 and 2010 in Tampere, Finland. 21 An increasing trend of supracondylar humerus fractures has been reported in many other developed countries, together with other upper extremity fractures. 16 The increase in incidence may be explained by changes in children's activity patterns.…”

“…19,20 Their in-hospital treatment has increased throughout 1987 to 2010, according to hospital discharge registries. 21 However, the current epidemiology of supracondylar humerus fractures is still poorly understood 22 and population-based studies are scarce. 23 Correspondingly, the recent incidence of pediatric supracondylar humerus fracture at population level is unknown.…”

Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues

“…Such a high rate of fixation failure would be alarming in any fracture or patient group. The issue is particularly important in children population, while the incidence of supracondylar fractures has increased by 30% since 2000 (27), and their in-hospital treatment is increasing (28). Nevertheless, the poor stability found in this study was not surprising; lateral-only pinning has been reported to be 40% weaker biomechanically when compared with crossing medial and lateral pinning (19).…”

Supracondylar humerus fractures in children: the effect of weather conditions on their risk

“…The rate of longterm morbidity is more than 40% in flexion-type supracondylar humerus fractures [17]. Further, the incidence and surgical treatment of supracondylar humerus fractures are increasing [13,26,29], resulting that any preventive interventions are justified to decrease these injuries. In order for preventative action to be effective, biological, environmental and behavioral background factors need to be understood.…”