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Archives of Orthopaedic and Trauma Surgery

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01-07-2020 | Clavicle Fracture | Trauma Surgery

Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study

Authors: Daniel Körner, Christoph Emanuel Gonser, Christian Bahrs, Philipp Hemmann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2020

Abstract

Introduction

Recent studies investigating the frequency of paediatric fractures in Germany are not available. The primary aim of this study was to report frequencies of the most common paediatric upper extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time.

Methods

This study used inpatient data from the German National Hospital Discharge Registry. Absolute frequencies and incidences of the following fracture localisations were analysed: clavicle, proximal humerus, humerus shaft, distal humerus, ulna shaft, radius shaft, forearm shaft, distal radius, and distal forearm. Four age groups were formed: 0–4, 5–9, 10–14, and 15–19 years. The boy–girl ratio (BGR) was calculated for all fracture localisations for both years, respectively. Incidence rate ratios (IRRs) were calculated to compare fracture incidences between 2002 and 2017.

Results

The absolute number of the nine fracture localisations together decreased from 38,480 in 2002 to 35,128 in 2017. The overall BGR was 2.0 in both years. The BGR increased with increasing patient age. The incidence of clavicle fractures increased from 2002 to 2017 (IRR ≥ 1.72), while that of humerus fractures (proximal, shaft, and distal) remained the same or decreased (IRR ≤ 1.00) within all age groups. The incidence of isolated ulna or radius shaft fractures increased slightly or remained the same in the two lower age groups (IRR ≥ 1.00), while it decreased in the two higher age groups (IRR ≤ 0.80). Furthermore, complete forearm fractures were more frequent in the 0–4, 5–9, and 10–14 year age groups (IRR ≥ 1.44) in 2017 compared to 2002. The incidence of distal radius und forearm fractures changed only slightly.

Conclusions

The absolute number of paediatric upper extremity fractures decreased from 2002 to 2017, while the incidence of in-hospital treatment of clavicle and forearm fractures increased significantly, indicating a trend towards operative treatment.

Jones IE, Williams SM, Dow N, Goulding A (2002) How many children remain fracture-free during growth? A longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study. Osteoporos Int 13:990–995. https://doi.org/10.1007/s001980200137 CrossRefPubMed

Kopjar B, Wickizer TM (1998) Fractures among children: incidence and impact on daily activities. Inj Prev 4:194–197. https://doi.org/10.1136/ip.4.3.194 CrossRefPubMedPubMedCentral

Tan SHS, Dartnell J, Lim AKS, Hui JH (2018) Paediatric lateral condyle fractures: a systematic review. Arch Orthop Trauma Surg 138:809–817. https://doi.org/10.1007/s00402-018-2920-2 CrossRefPubMed

Nakaniida A, Sakuraba K, Hurwitz EL (2014) Pediatric orthopaedic injuries requiring hospitalization: epidemiology and economics. J Orthop Trauma 28:167–172. https://doi.org/10.1097/BOT.0b013e318299cd20 CrossRefPubMed

Abdullah F, Gabre-Kidan A, Zhang Y, Sharpe L, Chang DC (2009) Report of 2,087,915 surgical admissions in U.S. children: inpatient mortality rates by procedure and specialty. World J Surg 33:2714–2721. https://doi.org/10.1007/s00268-009-0219-8 CrossRefPubMed

Landin LA (1997) Epidemiology of children’s fractures. J Pediatr Orthop B 6:79–83CrossRef

Hedstrom EM, Svensson O, Bergstrom U, Michno P (2010) Epidemiology of fractures in children and adolescents. Acta Orthop 81:148–153. https://doi.org/10.3109/17453671003628780 CrossRefPubMedPubMedCentral

Hedstrom EM, Bergstrom U, Michno P (2012) Injuries in children and adolescents—analysis of 41,330 injury related visits to an emergency department in northern Sweden. Injury 43:1403–1408. https://doi.org/10.1016/j.injury.2011.01.027 CrossRefPubMed

Lempesis V, Rosengren BE, Nilsson JA, Landin L, Tiderius CJ, Karlsson MK (2017) Time trends in pediatric fracture incidence in Sweden during the period 1950–2006. Acta Orthop 88:440–445. https://doi.org/10.1080/17453674.2017.1334284 CrossRefPubMedPubMedCentral

10.

Naranje SM, Erali RA, Warner WCJ, Sawyer JR, Kelly DM (2016) Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop 36:e45–e48. https://doi.org/10.1097/BPO.0000000000000595 CrossRefPubMed

11.

Ma D, Jones G (2003) Television, computer, and video viewing; physical activity; and upper limb fracture risk in children: a population-based case control study. J Bone Miner Res 18:1970–1977. https://doi.org/10.1359/jbmr.2003.18.11.1970 CrossRefPubMed

12.

Lyons RA, Sellstrom E, Delahunty AM, Loeb M, Varilo S (2000) Incidence and cause of fractures in European districts. Arch Dis Child 82:452–455. https://doi.org/10.1136/adc.82.6.452 CrossRefPubMedPubMedCentral

13.

Renné J, Weller S (1974) Verrenkungen und Frakturen der Oberen Gliedmaßen. In: Rehn J (ed) Unfallverletzungen bei Kindern, 1st edn. Springer, Berlin, pp 275–293CrossRef

14.

German Federal Statistical Office. Diagnosedaten der Krankenhäuser ab 2000 (Fälle, Berechnungs- und Belegungstage, durchschnittliche Verweildauer). Gliederungsmerkmale: Jahre, Behandlungsort, Alter, Geschlecht, Verweildauer, ICD10-4-Steller. http://www.gbe-bund.de. (Accessed 1 Aug 2019)

15.

German Federal Statistical Office. Diagnosedaten der Krankenhäuser ab 2000 (Fälle/Sterbefälle, Fälle je 100000 Einwohner). Gliederungsmerkmale: Jahre, Wohnsitz, Alter, Geschlecht, Verweildauer, ICD-4-Steller, Art der Standardisierung. http://www.gbe-bund.de. Accessed 1 Aug 2019

16.

German Federal Statistical Office. Bevölkerung (Zensus): Deutschland, Stichtag, Geschlecht, Familienstand (12111-0005). https://www-genesis.destatis.de/genesis/online. (Accessed 4 Sept 2019)

17.

Beck JJ, Richmond CG, Tompkins MA, Heyer A, Shea KG, Cruz AI (2018) What’s new in pediatric upper extremity sports injuries? J Pediatr Orthop 38:e73–e77. https://doi.org/10.1097/BPO.0000000000001104 CrossRefPubMed

18.

Pace JL (2016) Pediatric and adolescent forearm fractures: current controversies and treatment recommendations. J Am Acad Orthop Surg 24:780–788. https://doi.org/10.5435/JAAOS-D-15-00151 CrossRefPubMed

19.

Wang H, Feng C, Liu H, Liu J, Ou L, Yu H, Xiang L (2019) Epidemiologic features of traumatic fractures in children and adolescents: a 9-year retrospective study. Biomed Res Int 2019:8019063. https://doi.org/10.1155/2019/8019063 CrossRefPubMedPubMedCentral

20.

Mathison DJ, Agrawal D (2010) An update on the epidemiology of pediatric fractures. Pediatr Emerg Care 26:594–596. https://doi.org/10.1097/PEC.0b013e3181eb838d CrossRefPubMed

21.

Lyons RA, Delahunty AM, Kraus D, Heaven M, McCabe M, Allen H, Nash P (1999) Children’s fractures: a population based study. Inj Prev 5:129–132. https://doi.org/10.1136/ip.5.2.129 CrossRefPubMedPubMedCentral

22.

Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP (2004) Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res 19:1976–1981. https://doi.org/10.1359/JBMR.040902 CrossRefPubMed

23.

Mayranpaa MK, Makitie O, Kallio PE (2010) Decreasing incidence and changing pattern of childhood fractures: a population-based study. J Bone Miner Res 25:2752–2759. https://doi.org/10.1002/jbmr.155 CrossRefPubMed

24.

Cheng JC, Shen WY (1993) Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 7:15–22CrossRef

25.

Joeris A, Lutz N, Wicki B, Slongo T, Audige L (2014) An epidemiological evaluation of pediatric long bone fractures—a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 14:314. https://doi.org/10.1186/s12887-014-0314-3 CrossRefPubMedPubMedCentral

26.

German Federal Statistical Office. Bevölkerung (Zensus): Deutschland, Jahre, Nationalität, Geschlecht, Altersjahre (12411-0041). https://www-genesis.destatis.de/genesis/online. (Accessed 8 Sept 2019)

27.

Valerio G, Galle F, Mancusi C, Di Onofrio V, Colapietro M, Guida P, Liguori G (2010) Pattern of fractures across pediatric age groups: analysis of individual and lifestyle factors. BMC Public Health 10:656. https://doi.org/10.1186/1471-2458-10-656 CrossRefPubMedPubMedCentral

28.

Caird MS (2012) Clavicle shaft fractures: are children little adults? J Pediatr Orthop 32(Suppl 1):S1–S4. https://doi.org/10.1097/BPO.0b013e31825870ad CrossRefPubMed

29.

Shannon EG, Hart ES, Grottkau BE (2009) Clavicle fractures in children: the essentials. Orthop Nurs 28:210–216. https://doi.org/10.1097/NOR.0b013e3181b57a27 CrossRefPubMed

30.

von Laer L, Kraus R, Linhart W (2012) Frakturen im Bereich des Schultergürtels und des Humerusschaftes. In: von Laer L, Kraus R, Linhart W (eds) Frakturen und Luxationen im Wachstumsalter, 6th edn. Stuttgart, New York, pp 108–133

31.

Omid R, Choi PD, Skaggs DL (2008) Supracondylar humeral fractures in children. J Bone Joint Surg Am 90:1121–1132. https://doi.org/10.2106/JBJS.G.01354 CrossRefPubMed

32.

Gottschalk HP, Eisner E, Hosalkar HS (2012) Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg 20:223–232. https://doi.org/10.5435/JAAOS-20-04-223 CrossRefPubMed

33.

von Laer L, Kraus R, Linhart W (2012) Verletzungen im Bereich des Ellenbogens. In: von Laer L, Kraus R, Linhart W (eds) Frakturen und Luxationen im Wachstumsalter, 6th edn. Stuttgart, New York, pp 133–207

34.

von Laer L, Kraus R, Linhart W (2012) Frakturen im Bereich des Vorderarmschafts. In: von Laer L, Kraus R, Linhart W (eds) Frakturen und Luxationen im Wachstumsalter, 6th edn. Stuttgart, New York, pp 207–238

35.

Lieber J (2014) Growth behavior after fractures of the distal forearm: reasons for the high rate of overtreatment. Unfallchirurg 117:1092–1098. https://doi.org/10.1007/s00113-014-2633-0 CrossRefPubMed

Title: Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study
Authors: Daniel Körner
Christoph Emanuel Gonser
Christian Bahrs
Philipp Hemmann
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Clavicle Fracture
Forearm Fracture
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03321-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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