02 Epidemiology

7/25/2019 02 Epidemiology

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Manuel Cassiano NevesLisbon Childrens Hospital &

Hospital CUF Descobertas - Lisbon

The Epidemiologyof fractures in

children


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Is it common to have a fracture during

childhood ?

Any factors influencing fractures in

children & adolescents ?


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The incidence of fractures during childhood

almost doubled between the 1950s and the

1970s.

Landin LA. Fracture patterns in children.Acta Orthop Scand1983;202:13


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Chance of a child sustaining a fracture during

childhood in Sweden (birth to age 16)

Landin LA. Fracture patterns in children.Acta Orthop Scand1983;202:13

42% 27%


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Landin LA. Incidence of fractures by age. Fracture patterns in children.Acta Orthop Scand1983;202:13

Worlock P, Stower M. Fracture patterns in Nottingham children.J Pediatr Orthop1986;6:656

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

(2,6% for boys; 1,7% for girls) sustained at least onefracture each year

The overall chance of fracture per year was 1,6% for bothgirls and boys in a study from England of both

outpatients and inpatients


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A third of boys and girls (Edinburgh

Scotland)can expect to have a fracture before 16 years ofage

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

The epidemiology of fractures in children.

J Care Injured 2007(38);913-922

25% Children injured / year

10 - 25% = Fractures


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Cultural Differences

Climatic DifferencesSeasonal Variations

Age

Location

Any factors influencing fractures inchildren & adolescents ?


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Age

Landin LA. Incidence of fractures by age. Fracture patterns in children.Acta Orthop Scand1983;202:13

0 5 10 15 AGE

100

200

300

400

500

Boys

Girls


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Age

0 10 16 AGE

1000

2000

3000

4000

5000

Boys

Girls

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

2 4 6 8 12 14


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Age

Age Group PrevalanceIncidence

1000 / year

Male :

Female

Upper /

Lower Limb

5 Commonest

Fractures

0 - 1 2.1 3.6 47 : 53 78 : 22

Clavicule 22.2%

Distal humerus 22.2%

Distal radius 11.1%

Radius / Ulna Diaphysis

Tibia & Fibula

2 - 4 11.6 12.9 53 : 47 76 : 24


Distal radius 21.3%

Clavicul 15.0%


Finger phalanges

5 - 11 51.3 23.2 54 : 46 85 : 15

Distal radius 40.3%

Finger phalange 14.4%

Distal humerus 7.5%


Metacarpus

12 - 16 33.8 26.6 77 : 23 79 : 21

Distal radius 28.0%

Finger phalanges 20.3%

Metacarpus 14.3%

Clavicle

Metatarsus

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


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Age

0

5

10

15

0-3 yrs (%)

20

25

30

35

4-7 yrs (%) 8-11 yrs (%) 12-16 yrs (%)

Distal Radius

Supracondylar

Forearm Shaft

Tibial Shaft


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EPOS-EFORT

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Rockwood & WilkinsFractures in Children. 6th Edtition. Louise RennieJ Care Injured

%

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 1

Humerus (proximal and shaft) 1.4 1,8


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0 5 10 15AGE

Late Peak

Bimodal

0 5 10 15AGE

Distal ForearmPhalanges

Prox. Humerus

Clavicle

FemurRadius - Ulna

0 5 10 15AGE

Rising

AnkleCarpal -

Metacarpals

0 5 10 15AGE

Early Peak

Supracondylar

Humerus


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Mechanism

of InjuryPrevalance % Mean Age

Male :

Female

Upper /

Lower Limb

5 Commonest

Fractures

Fall below

bed height37.4 8.7 64 : 36 93 : 7

Distal radius 50.0%

Clavicule 9.0%

Distal humerus 7.9%

Finger / Phalanges


Blunt trauma 18.8 10.9 71 : 29 81 : 19

Finger phalanges 43.8%

Metacarpus 22.1%

Toe phalanges 12.7%Distal radius

Metatarsus

Falls from

above bed

height17.2 7.8 62 : 38 83 : 17

Distal radius 37.7%


Radius / Ulna Diaph 9.1%

Clavicle

Metatarsus

Sports 12.1 12.4 78 : 22 82 : 18

Finger phalanges 28.6%Distal radius 26.7%

Clavicle 11.3%

Metacarpus

Tibia & Fibula


Mechanism of Injury


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Mechanism of Injury

Mechanism

of Injury Prevalance %

Mean Age

Male :

Female

Upper /

Lower Limb

5 Commonest

Fractures

Road traffic

accidents6.7 10.2 69 : 31 70 : 30

Distal radius 30.6%

Tibia & Fibula 11.0%

Finger / Phalanges 6.8%

Femoral diaphysis

Metacarpus

Twist 4.2 10.6 53 : 47 14 : 86

Ankle 40.2%

Metatarsus 39.1%Finger phalanges 4.3%

Tibia & Fibula

Metacarpus

Falls down

stairs &

slopes2.4 7.6 48 : 52 69 : 31

Distal radius 32.7%

Clavicle 13.5%

Metatarsus 11.5%


Distal humerus

Stress,

Pathological

or Unknown

0.5

0.5


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Type Road / Traffic Accident

Type of road

/ trafficaccident

Prevalance %

Mean Age

Male :Female Upper /Lower Limb 5 CommonestFractures

Cyclists 67.3 10.5 69 : 31 89 : 11

Distal radius 41.4%

Proximal humerus 10.1%

Metacarpus 8.1%

Finger phalanges

Proximal radius / ulna

Pedestrians 23.8 9.0 69 : 31 13 : 87


Distal tibia 14.3%

Femoral Diaphysis 11.4%

Pelvis

Humeral diaphysis

Motor

cyclists

6.1 12.6 100 : 0 78 : 22

Clavicle

22.2%

Finger phalanges

22.2%

Distal radius 22.2%Tibia & Fibula

Radius / Ulna diaphysis

Passsangers 2.7 9.7 25 : 75 50 : 50

Femoral Diaphysis 33.3%

Proximal humerus 33.3%




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Rockwood & WilkinsFractures in Children.

6th Edtition. Louise RennieJ Care Injured

Total fractures

= 6,477

Number of physeal injuries

= 1,404

Percentage of physeal injuries

= 21.7% (14,8%)

Incidence of Physeal Fractures in Long Bones


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

Children Adults

Incidence / 1000 / year

Male : Female (%)

Isolated fractures (%)Open fractures (%)

Lower limb (%)

Upper limb (%)

Spine & Pelvis (%)

20.2

61 : 39

94.40.7

17.3

82.2

0.5

11.1

50 : 50

98.83.1

39.1

58.7

2.2

Comparative epidemiological data on

pediatric and adult fractures

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#s in children > frequent than adults

#s more common in males

High incidence of Upper Limb #s

Open, pelvis & Spine #s are rare

Conclusion:

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02 Epidemiology