Stable incidence of surgical treatment and hospitalisation for humeral shaft fractures among 0- to 16-year-old patients in Finland from 1987 to 2010

Abstract

BackgroundStudies among children experiencing fractures report an increasing trend toward operative management. In the present study, we examined whether the same trend has occurred for humeral shaft fractures in accordance with increasing interest toward intramedullary nailing and other operative treatments. The number, incidence and treatment of all hospitalised 0- to 16-year-old patients with humeral shaft fractures in Finland was assessed over a recent 24-year period.MethodThe study included the entire adolescent (0–16 years) population in Finland during the 24-year period from January 1, 1987, to December 31, 2010. Data on hospitalised patients who sustained humeral shaft fractures were obtained from the nationwide National Hospital Discharge Register (NHDR) of Finland.ResultsDuring the study period, there were a total of 1,165 hospitalisations with a main or secondary diagnosis of humeral shaft fracture. The incidence of hospitalisation due to humeral shaft fractures was 4.8 per 100,000 person-years. The incidence increased only slightly among girls from 3.3 per 100,000 person-years in 1987 to 5.3 per 100,000 person-years in 2010. The incidence of reposition and casting was 1.1 per 100,000 person-years and the incidence of reposition with osteosynthesis, including intramedullary nailing, was 1.4 per 100,000 person-years. The specific incidence of intramedullary nailing remained low with no signs of increased incidence, and the incidence was 0.3 per 100,000 person-years. There were no significant changes in the incidence of surgical treatment during the 24-year study period.ConclusionDespite an overall increasing trend toward operative management of fractures in children, conservative management remains the treatment of choice for humeral shaft fractures based on the low and steady incidence of surgical treatment during the 24-year study period. In addition, the incidence of hospitalisation for fractures remained low without a significant increase during the study period.

Epidemiology of proximal and diaphyseal humeral fractures in children: an observational study from the Swedish Fracture Register

“…The earlier peak in injuries amongst girls compared to boys could be explained by earlier puberty and growth spurt which causes a decrease in bone mineral density, making pubertal children more vulnerable to fractures [ 18 ]. In addition, our peak occurrences in diaphyseal fractures among infants and adolescents were also in line with other studies [ 5 , 19 ]. The high incidence amongst infants can be explained by birth-related traumas, while traffic-related fractures might explain the increase in adolescents which is comparable with the cause of humeral fractures in adults [ 20 ].…”

“…In a Finnish study on proximal fractures, 8% were treated surgically [ 12 ] which corresponds well with our findings (7% in boys and 5% in girls). In another Finnish study on diaphyseal fractures, 50% of all hospitalised children required surgery and/or fracture reduction [ 19 ]. In our population 20% of all patients with diaphyseal fractures were treated surgically or had a fracture reduction.…”

Epidemiology Of Proximal And Diaphyseal Humeral Fractures In Children: An Observational Study From The Swedish Fracture Register

“…The earlier peak in injuries amongst girls compared to boys could be explained by earlier puberty and growth spurt which causes a decrease in bone mineral density, making pubertal children more vulnerable to fractures (16). In addition, our peak occurrences in diaphyseal fractures among infants and adolescents were also in line with other studies (4,17). The high incidence amongst infants can be explained by birth-related traumas, while tra c-related fractures might explain the increase in adolescents which is comparable with the cause of humeral fracture in adults (18).…”

“…In a Finnish study on proximal fractures, 8% were treated surgically (12) which corresponds well with our ndings (7% in boys and 5% in girls). In another Finnish study on diaphyseal fractures, 50% of all hospitalised children required surgery and/or fracture reduction (17). In our population 20% of all patients with diaphyseal fractures were treated surgically or had a fracture reduction.…”

Delayed Radial Nerve Palsy after Closed Reduction of a Pediatric Humeral Shaft Fracture

“…In such cases, early exploration of the fracture site is recommended in order to provide ample opportunity for the nerve to obtain functional recovery [ 2 ]. In the pediatric population, a vast majority of humeral shaft fractures are treated nonoperatively [ 3 ].…”