Epidemiology of pediatric femur fractures in children: the Swedish Fracture Register
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(2020) 21:796
RESEARCH ARTICLE
Open Access
Epidemiology of pediatric femur fractures in children: the Swedish Fracture Register Zandra Engström* , Olof Wolf† and Yasmin D. Hailer†
Abstract Background: Although femur fractures in children are rare, they are the most common fractures in need of hospitalization. We sought to describe the epidemiology and treatment of pediatric femur fractures recorded in the Swedish Fracture Register (SFR). We also studied the relationship between femur fractures, age, sex, fracture pattern, injury mechanism, seasonal variation and treatment. Methods: This nationwide observational register study was based on the pediatric part of the SFR. We included all patients < 16 years of age who were registered in the SFR from 2015 to 2018. Results: Of the 709 femur fractures, 454 (64%) occurred in boys. Sixty-two of these fractures were proximal (9%), 453 shaft (64%) and 194 distal (27%). A bimodal age distribution peak was observed in boys aged 2–3 and 16–19 years. In contrast, the age distribution among girls was evenly distributed. Younger children were mainly injured by a fall, whereas older children sustained their fracture because of traffic accidents. Non-surgical treatment prevailed among younger children; however, prevalence of surgical treatment increased with age. Conclusions: We found a lower ratio between boys and girls (1.8:1) compared to earlier studies. The bimodal age distribution was seen only in boys. Falls were the most common injury in younger children, whereas traffic-related accidents were the most common in adolescents. With age, there was a corresponding increase in surgical treatment. Keywords: Femur, Fracture, Children, Epidemiology, Swedish FractureRegister
Background Clavicle and distal forearm fractures, primarily treated in an outpatient setting, are the most common fractures in children [1]. Although pediatric femur fractures are rare, they remain the most common traumatic orthopedic injury requiring hospitalization [2, 3]. According to Heideken et al., pediatric femur shaft fractures in Sweden in 2005 were 11.3 per 100,000. However, the frequency of this type of fracture has decreased markedly (42%) since 1987. One explanation for the decrease in femur fractures is increased safety in Swedish traffic, although a * Correspondence: [email protected] † Olof Wolf and Yasmin D. Hailer contributed equally to this work. Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
reduction in children’s physical activity may also play a role [4]. Femur fractures are more common in boys than in girls [4–6] and boys seem to have a bimodal incidence peak between the ages 2 and 3 and 16 and 19 years [5]. Unlike adults, most femur fractures in children are shaft fractures, followed by distal and then proximal fractures [6]. The injury mechanism depends on the child’s age, with younger children most likely to be injured by falls and older children and adolescents by traffic-related accidents [4–6]. In children < 1 year of age and who ha
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