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    The Epidemiology of Fractures in Children: Manuel Cassiano Neves

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    Ana-Maria Dulea
    1) Fractures are common in children, with around 42% of children sustaining a fracture by age 16. The incidence of fractures in children almost doubled between the 1950s and 1970s. 2) The risk of fracture varies depending on age and sex, with peak rates occurring between ages 5-11 for boys and 12-16 for girls. The most common fracture sites also change with age. 3) The leading causes of pediatric fractures are falls, especially falls from standing height, and sports-related injuries. Road accidents and twisting injuries are less frequent causes.

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    The Epidemiology of Fractures in Children: Manuel Cassiano Neves

    Uploaded by

    Ana-Maria Dulea
    68 views20 pages
    1) Fractures are common in children, with around 42% of children sustaining a fracture by age 16. The incidence of fractures in children almost doubled between the 1950s and 1970s. 2) The risk of fracture varies depending on age and sex, with peak rates occurring between ages 5-11 for boys and 12-16 for girls. The most common fracture sites also change with age. 3) The leading causes of pediatric fractures are falls, especially falls from standing height, and sports-related injuries. Road accidents and twisting injuries are less frequent causes.

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    orthopaedhics

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    02 Epidemiology

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    1) Fractures are common in children, with around 42% of children sustaining a fracture by age 16. The incidence of fractures in children almost doubled between the 1950s and 1970s. 2) The risk of fracture varies depending on age and sex, with peak rates occurring between ages 5-11 for boys and 12-16 for girls. The most common fracture sites also change with age. 3) The leading causes of pediatric fractures are falls, especially falls from standing height, and sports-related injuries. Road accidents and twisting injuries are less frequent causes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    68 views20 pages

    The Epidemiology of Fractures in Children: Manuel Cassiano Neves

    Uploaded by

    Ana-Maria Dulea
    1) Fractures are common in children, with around 42% of children sustaining a fracture by age 16. The incidence of fractures in children almost doubled between the 1950s and 1970s. 2) The risk of fracture varies depending on age and sex, with peak rates occurring between ages 5-11 for boys and 12-16 for girls. The most common fracture sites also change with age. 3) The leading causes of pediatric fractures are falls, especially falls from standing height, and sports-related injuries. Road accidents and twisting injuries are less frequent causes.

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    EPOS-EFORT

    BAT Trauma Course

    The Epidemiology
    of fractures in
    children
    Manuel Cassiano Neves
    Lisbon Childrens Hospital &
    Hospital CUF Descobertas - Lisbon

    EPOS-EFORT
    BAT Trauma Course

    Is it common to have a fracture during

    childhood ?
    Any factors influencing fractures in
    children & adolescents ?

    EPOS-EFORT
    BAT Trauma Course

    The incidence of fractures during childhood


    almost doubled between the 1950s and the
    1970s.

    Landin LA. Fracture patterns in children.


    Acta Orthop Scand 1983;202:13

    EPOS-EFORT
    BAT Trauma Course

    Chance of a child sustaining a fracture during

    childhood in Sweden (birth to age 16)

    42%

    27%
    Landin LA. Fracture patterns in children.
    Acta Orthop Scand 1983;202:13

    EPOS-EFORT
    BAT Trauma Course

    When considered on an annual basis, 2,1% of all children


    (2,6% for boys; 1,7% for girls) sustained at least one
    fracture each year
    Landin LA. Incidence of fractures by age. Fracture patterns in children.
    Acta Orthop Scand 1983;202:13

    The overall chance of fracture per year was 1,6% for both
    girls and boys in a study from England of both
    outpatients and inpatients
    Worlock P, Stower M. Fracture patterns in Nottingham children.
    J Pediatr Orthop 1986;6:656

    EPOS-EFORT
    BAT Trauma Course

    25% Children injured / year


    10 - 25% = Fractures

    A third of boys and girls (Edinburgh Scotland)


    can expect to have a fracture before 16 years of
    age
    Rennie L, Court-Brown CM, Mok JYK, Beattie TF.
    The epidemiology of fractures in children.
    J Care Injured 2007(38);913-922

    Any factors influencing fractures in


    children & adolescents ?

    Cultural Differences

    Climatic Differences
    Seasonal Variations
    Age
    Location

    EPOS-EFORT
    BAT Trauma Course

    EPOS-EFORT
    BAT Trauma Course

    Age

    Boys
    Girls

    500
    400
    300
    200
    100
    0

    10

    15

    AGE

    Landin LA. Incidence of fractures by age. Fracture patterns in children.


    Acta Orthop Scand 1983;202:13

    EPOS-EFORT
    BAT Trauma Course

    Age

    Boys
    Girls

    5000
    4000
    3000
    2000
    1000
    0

    10

    12

    14

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of


    fractures in children. J Care Injured 2007(38);913-922

    16

    AGE

    EPOS-EFORT
    BAT Trauma Course

    Age
    Age Group

    0-1

    2-4

    5 - 11

    12 - 16

    Prevalance

    2.1

    11.6

    51.3

    33.8

    Incidence
    1000 / year
    3.6

    12.9

    23.2

    26.6

    Male :
    Female
    47 : 53

    53 : 47

    54 : 46

    77 : 23

    Upper /
    Lower Limb

    5 Commonest
    Fractures

    78 : 22

    Clavicule
    22.2%
    Distal humerus
    22.2%
    Distal radius
    11.1%
    Radius / Ulna Diaphysis
    Tibia & Fibula

    76 : 24

    Distal humerus
    22.0%
    Distal radius
    21.3%
    Clavicul
    15.0%
    Radius / Ulna Diaphysis
    Finger phalanges

    85 : 15

    79 : 21

    Distal radius
    40.3%
    Finger phalange
    14.4%
    Distal humerus
    7.5%
    Radius / Ulna Diaphysis
    Metacarpus
    Distal radius
    Finger phalanges
    Metacarpus
    Clavicle
    Metatarsus

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of fractures in
    children. J Care Injured 2007(38);913-922

    28.0%
    20.3%
    14.3%

    EPOS-EFORT
    BAT Trauma Course

    Age

    Distal Radius

    35

    Supracondylar

    30

    Forearm Shaft

    25

    Tibial Shaft

    20
    15

    10
    5
    0
    0-3 yrs (%)

    4-7 yrs (%)

    8-11 yrs (%)

    12-16 yrs (%)

    EPOS-EFORT
    BAT Trauma Course

    Incidence of Specific Fracture Types

    %
    Distal radius and physis

    23.3 32,9

    Hand (carpals, metacarpals, and phalanges)

    20.1 15,3

    Elbow area (distal humerus and prox. radius and ulna)

    12.0 11,3

    Clavicle

    6.4

    7,3

    Radius shaft

    6.4

    5,4

    Tibia shaft

    6.2

    2,5

    Foot (metatarsals and phalanges)

    5.9

    7,8

    Ankle (distal tibia)

    4.4

    1,7

    Femur (neck and shaft)

    2.3

    Humerus (proximal and shaft)

    1.4

    1,8

    Rockwood & Wilkins Fractures in Children. 6th Edtition. Louise Rennie J Care Injured

    EPOS-EFORT
    BAT Trauma Course

    Bimodal

    Early Peak

    Clavicle
    Femur
    Radius - Ulna

    Supracondylar
    Humerus

    10

    15

    AGE

    Rising

    10

    15

    Late Peak

    Distal Forearm
    Phalanges
    Prox. Humerus

    Ankle
    Carpal Metacarpals

    10

    AGE

    15

    AGE

    10

    15

    AGE

    EPOS-EFORT
    BAT Trauma Course

    Mechanism of Injury
    Mechanism
    of Injury
    Fall below
    bed height

    Blunt trauma
    Falls from
    above bed
    height
    Sports

    Prevalance %

    37.4

    18.8

    17.2

    12.1

    Mean Age

    8.7

    10.9

    7.8

    12.4

    Male :
    Female
    64 : 36

    71 : 29

    62 : 38

    78 : 22

    Upper /
    Lower Limb

    5 Commonest
    Fractures

    93 : 7

    Distal radius
    50.0%
    Clavicule
    9.0%
    Distal humerus
    7.9%
    Finger / Phalanges
    Radius / Ulna Diaphysis

    81 : 19

    83 : 17

    82 : 18

    Finger phalanges
    Metacarpus
    Toe phalanges
    Distal radius
    Metatarsus

    43.8%
    22.1%
    12.7%

    Distal radius
    Distal humerus
    Radius / Ulna Diaph
    Clavicle
    Metatarsus

    37.7%
    21.4%
    9.1%

    Finger phalanges
    Distal radius
    Clavicle
    Metacarpus
    Tibia & Fibula

    28.6%
    26.7%
    11.3%

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of


    fractures in children. J Care Injured 2007(38);913-922

    EPOS-EFORT
    BAT Trauma Course

    Mechanism of Injury
    Mechanism
    of Injury
    Road traffic
    accidents

    Twist

    Prevalance %

    6.7

    4.2

    Falls down
    stairs &
    slopes

    2.4

    Stress,
    Pathological
    or Unknown

    0.5
    0.5

    Mean Age

    10.2

    10.6

    7.6

    Male :
    Female
    69 : 31

    53 : 47

    48 : 52

    Upper /
    Lower Limb

    5 Commonest
    Fractures

    70 : 30

    Distal radius
    Tibia & Fibula
    Finger / Phalanges
    Femoral diaphysis
    Metacarpus

    30.6%
    11.0%
    6.8%

    14 : 86

    Ankle
    Metatarsus
    Finger phalanges
    Tibia & Fibula
    Metacarpus

    40.2%
    39.1%
    4.3%

    69 : 31

    Distal radius
    32.7%
    Clavicle
    13.5%
    Metatarsus
    11.5%
    Radius / Ulna Diaphysis
    Distal humerus

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of


    fractures in children. J Care Injured 2007(38);913-922

    EPOS-EFORT
    BAT Trauma Course

    Type Road / Traffic Accident


    Type of road
    / traffic
    accident
    Cyclists

    Pedestrians

    Motor
    cyclists

    Passsangers

    Prevalance %

    67.3

    23.8

    6.1

    2.7

    Mean Age

    10.5

    9.0

    12.6

    9.7

    Male :
    Female

    69 : 31

    69 : 31

    100 : 0

    25 : 75

    Upper /
    Lower Limb

    5 Commonest
    Fractures

    89 : 11

    Distal radius
    41.4%
    Proximal humerus 10.1%
    Metacarpus
    8.1%
    Finger phalanges
    Proximal radius / ulna

    13 : 87

    Tibia & Fibula


    34.3%
    Distal tibia
    14.3%
    Femoral Diaphysis 11.4%
    Pelvis
    Humeral diaphysis

    78 : 22

    Clavicle
    22.2%
    Finger phalanges
    22.2%
    Distal radius
    22.2%
    Tibia & Fibula
    Radius / Ulna diaphysis

    50 : 50

    Femoral Diaphysis
    Proximal humerus
    Distal humerus
    Tibia & Fibula

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of


    fractures in children. J Care Injured 2007(38);913-922

    33.3%
    33.3%
    16.6%
    16.6%

    EPOS-EFORT
    BAT Trauma Course

    Incidence of Physeal Fractures in Long Bones


    Total fractures
    = 6,477
    Number of physeal injuries
    = 1,404
    Percentage of physeal injuries
    = 21.7% (14,8%)

    Rockwood & Wilkins Fractures in Children.


    6th Edtition. Louise Rennie J Care Injured

    EPOS-EFORT
    BAT Trauma Course

    Comparative epidemiological data on


    pediatric and adult fractures
    Incidence / 1000 / year
    Male : Female (%)
    Isolated fractures (%)
    Open fractures (%)
    Lower limb (%)
    Upper limb (%)
    Spine & Pelvis (%)

    Children

    Adults

    20.2
    61 : 39
    94.4
    0.7
    17.3
    82.2
    0.5

    11.1
    50 : 50
    98.8
    3.1
    39.1
    58.7
    2.2

    Rennie L, Court-Brown CM, Mok JYK, Beattie TF. The epidemiology of fractures in
    children. J Care Injured 2007(38);913-922

    EPOS-EFORT
    BAT Trauma Course

    Conclusion:
    #s in children > frequent than adults
    #s more common in males
    High incidence of Upper Limb #s
    Open, pelvis & Spine #s are rare

    EPOS-EFORT
    BAT Trauma Course

    20

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