Pediatric Distal Forearm Fracture Epidemiology in Malmö, Sweden-Time Trends During Six Decades.

Background The distal forearm fracture is the most common fracture in children. To allocate health care resources and evaluate if prevention strategies have been successful, it is essential to monitor changes in the epidemiology of common fractures. Methods Our hospital serves a city in which year 2006 included 276,244 inhabitants (49,664 <17 years of age). Through the hospital archives, we identified fractures sustained by individuals younger than 16 years during 2005 and 2006 and compared these with previous collected and published data from the same area and hospital for the period 1950 to 1994. We used official population data to estimate period-specific fracture rates and age and gender standardized time trends. We report rates as number of fractures per 100,000 person-years and changes between periods as rate ratios (RR) with 95% confidence intervals (CIs). Results We identified 521 distal forearm fractures, corresponding to a crude fracture incidence of 564/100,000 person-years (boys 719; girls 401). Age-adjusted fracture incidence was 70% higher in boys than in girls (RR 1.7; 95% CI 1.3-2.3). The age- and gender-adjusted hand fracture incidence was 40% higher in 2005-2006 than in 1950/1955 (RR 1.4; 95% CI 1.2 to 1.8) but no higher than 1993-1994 (RR 1.1; 95% CI 0.9-1.3). Fracture etiology of 2005 to 2006 included sports injuries in 41% and traffic accidents in 11% of the cases, while sports injuries explained 37% and traffic accidents 18% in 1950 to 1955. Conclusion In 2005 to 2006, we found higher rates in boys and higher overall rates compared with the 1950s but no significant differences compared with the rates in 1993 to 1994. Future studies should include patient-specific data to unravel causal factors. Level of evidence This is a Level III b study.

Hand fracture epidemiology and etiology in children-time trends in Malmö, Sweden, during six decades.

BACKGROUND: The aim of this study was to describe hand fracture epidemiology/etiology in city children and describe time trend during six decades. PATIENTS AND METHODS: A single hospital serves the entire city population of 271,271 (year 2005). Through the hospital medical and radiological archives, we collected epidemiology and etiology data concerning pediatric (age < 16 years) hand fractures in city residents, treated during 2005-2006. We compared these data to previously collected data in in the same city during 12 evaluated periods from 1950/1955 to 1993-1994. We present period-specific crude and age- and gender-adjusted fracture incidence rates and group differences as incidence rate ratios (RR) with 95% confidence intervals (95% CI). RESULTS: In 2005-2006, we identified 414 hand fractures (303 in boys and 111 in girls), 247 phalangeal fractures (60% of all hand fractures), 140 metacarpal/carpal fractures (except the scaphoid bone) (34%), and 27 scaphoid fractures (6%). The crude hand fracture rate in children was 448/100,000 person years (639/100,000 in boys and 247/100,000 in girls), with a 2.5 times higher age-adjusted incidence in boys than in girls. Compared to 1950/1955, the age and gender-adjusted hand fracture incidence was twice as high in 2005-2006 and more than twice as high in 1976-1979. Compared to 1976-1979, we found no significant difference in the age and gender-adjusted hand fracture incidence in 2005-2006. In 2005-2006, sports injuries explained 42%, fights 20%, and traffic accidents 13% of the hand fractures. In 1950/1955, sports injuries explained 27% of fractures, fights 10%, and traffic accidents 21%. CONCLUSIONS: The incidence of hand fractures in children was more than twice as high in the end of the 1970s compared to the 1950s, where after no significant change could be found. Also, fracture etiology has changed. New studies are needed, to adequately allocate health care resources and identify new fracture prone activities suitable for preventive measures. LEVEL OF EVIDENCE: III.

Time trends in pediatric fracture incidence in Sweden during the period 1950-2006.

Background and purpose - Pediatric fracture incidence may not be stable. We describe recent pediatric fracture epidemiology and etiology and compare this to earlier data. Patients and methods - The city of Malmö (population 271,271 in 2005) in Sweden is served by 1 hospital. Using the hospital diagnosis registry, medical charts, and the radiographic archive, we identified fractures in individuals <16 years that had occurred during 2005 and 2006. We also retrieved previously collected fracture data from between 1950 and 1994, from the hospital's pediatric fracture database. We used official population data to estimate period-specific fracture incidence (the number of fractures per 105 person-years) and also age- and sex-adjusted incidence. Differences are reported as rate ratios (RRs) with 95% confidence intervals. Results - The pediatric fracture incidence during the period 2005-2006 was 1,832 per 105 person-years (2,359 in boys and 1,276 in girls), with an age-adjusted boy-to-girl ratio of 1.8 (1.6-2.1). Compared to the period 1993-1994, age-adjusted rates were unchanged (RR =0.9, 95% CI: 0.8-1.03) in 2005-2006, with lower rates in girls (RR =0.8, 95% CI: 0.7-0.99) but not in boys (RR =1.0, 95% CI: 0.9-1.1). We also found that the previously reported decrease in unadjusted incidence in Malmö from 1976-1979 to 1993-1994 was based on changes in demography, as the age-adjusted incidences were similar in the 2 periods (RR =1.0, 95% CI: 0.9-1.1). Interpretation - In Malmö, pediatric fracture incidence decreased from 1993-1994 to 2005-2006 in girls but not in boys. Changes in demography, and also other factors, influence the recent time trends.

Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications.

This study aims to describe the epidemiology of pediatric diaphyseal forearm fractures in an urban population and the complications of titanium elastic nailing. The medical records of 456 consecutive fractures were reviewed. The annual incidence was 0.7/1000 children. Eighty-six (19%) fractures in 83 children were titanium elastic nailed. The complication rate was 24%. Dorsal entry to the radius was associated with extensor pollicis longus rupture and radial entry was associated with sensory nerve deficit in three cases each. Seventy-eight (94%) of the operated patients recovered completely. Titanium elastic nailing is effective, but associated with a high rate of complications, most of which resolve spontaneously.

Increasing wrist fracture rates in children may have major implications for future adult fracture burden.

Background and purpose - Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skåne in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged ≤ 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period 1999-2010, the distal forearm fracture rate was 634 per 10(5) patient years (750 in boys and 512 in girls). This was 50% higher than in the 1950s with a different age-rate distribution (p < 0.001) that was most evident during puberty. Also, within the period 1999-2010, there were increasing fracture rates per 10(5) and year (boys +2.0% (95% CI: 1.5-2.6), girls +2.4% (95% CI: 1.7-3.1)). Interpretation - The distal forearm fracture rate in children is currently 50% higher than in the 1950s, and it still appears to be increasing. If this higher fracture risk follows the children into old age, numbers of fragility fractures may increase sharply-as an upturn in life expectancy has also been predicted. The origin of the increase remains unknown, but it may be associated with a more sedentary lifestyle or with changes in risk behavior.

Preterm Children Born Small for Gestational Age are at Risk for Low Adult Bone Mass.

Cross-sectional studies suggest that premature birth and low birth weight may both be associated with low peak bone mass. We followed bone traits in preterm individuals and controls for 27 years and examined the effects of birth weight relative to gestational age [stratified as small for gestational age (SGA) or appropriate for gestational (AGA)] on adult bone mineral density (BMD). We measured distal forearm BMC (g/cm) and BMD (g/cm(2)) with single-photon absorptiometry (SPA) in 46 preterm children (31 AGA and 15 SGA) at mean age 10.1 years (range 4-16) and in 84 healthy age-matched children. The measurements were repeated 27 years later with the same SPA apparatus but then also with dual energy absorptiometry and peripheral computed tomography (pQCT). Preterm individuals were shorter (p = 0.03) in adulthood than controls. Preterm AGA individuals had similar BMC and BMD height-adjusted Z-scores in adulthood compared to controls. Preterm SGA individuals had lower distal forearm BMC and BMD height-adjusted Z-scores in adulthood than both controls and preterm AGA individuals. Preterm SGA individuals had lower gain from childhood to adulthood in distal forearm BMC height-adjusted Z-scores than controls (p = 0.03). The deficits in preterm SGA individuals in adulthood were also captured by DEXA in height-adjusted femoral neck (FN) BMC Z-score and height-adjusted FN BMD Z-score and by pQCT in tibial cross-sectional area (CSA) Z-score and stress strain index (SSI) Z-score, where all measurements were lower than controls (all p values <0.05). Preterm SGA individuals are at increased risk of reaching low adult bone mass, at least partly due to a deficit in the accrual of bone mineral during growth. In our cohort, we were unable to find a similar risk in preterm AGA individuals.

A pediatric bone mass scan has poor ability to predict adult bone mass: a 28-year prospective study in 214 children.

As the correlation of bone mass from childhood to adulthood is unclear, we conducted a long-term prospective observational study to determine if a pediatric bone mass scan could predict adult bone mass. We measured cortical bone mineral content (BMC [g]), bone mineral density (BMD [g/cm(2)]), and bone width (cm) in the distal forearm by single photon absorptiometry in 120 boys and 94 girls with a mean age of 10 years (range 3-17) and mean 28 years (range 25-29) later. We calculated individual and age-specific bone mass Z scores, using the control cohort included at baseline as reference, and evaluated correlations between the two measurements with Pearson's correlation coefficient. Individual Z scores were also stratified in quartiles to register movements between quartiles from growth to adulthood. BMD Z scores in childhood and adulthood correlated in both boys (r = 0.35, p < 0.0001) and girls (r = 0.50, p < 0.0001) and in both children ≥10 years at baseline (boys r = 0.43 and girls r = 0.58, both p < 0.0001) and children <10 years at baseline (boys r = 0.26 and girls r = 0.40, both p < 0.05). Of the children in the lowest quartile of BMD, 58% had left the lowest quartile in adulthood. A pediatric bone scan with a value in the lowest quartile had a sensitivity of 48% (95% confidence interval [CI] 27-69%) and a specificity of 76% (95% CI 66-84%) to identify individuals who would remain in the lowest quartile also in adulthood. Childhood forearm BMD explained 12% of the variance in adult BMD in men and 25% in women. A pediatric distal forearm BMD scan has poor ability to predict adult bone mass.

Does a childhood fracture predict low bone mass in young adulthood? A 27-year prospective controlled study.

A fracture in childhood is associated with low bone mineral density (BMD), but it is debated whether a fracture at growth also predicts low BMD in young adulthood. The purpose of this work was to gender-specifically evaluate whether children with a fracture are at increased risk of low BMD in young adulthood. Distal forearm BMD (g/cm2) was measured with single-photon absorptiometry (SPA) in 47 boys and 26 girls (mean age 10 years, range 3-16 years) with an index fracture and in 41 boys and 43 girls (mean age 10 years, range 4-16 years) with no fracture. BMD was re-measured mean 27 years later with the same SPA apparatus and with dual-energy absorptiometry (DXA), quantitative ultrasound (QUS), and peripheral computed tomography (pQCT). Individual Z-scores were calculated using the control cohort as reference population. Data are presented as means with 95% confidence intervals (95% CI) within brackets and correlation with Pearson's correlation coefficient. Boys with an index fracture had at fracture event a distal forearm BMD Z-score of -0.4 (95% CI, -0.7 to -0.1) and at follow-up -0.4 (95% CI, -0.7 to -0.1). Corresponding values in girls were -0.2 (95% CI, -0.5 to 0.1) and -0.3 (95% CI, -0.7 to 0.1). The deficit in absolute bone mass was driven by men with index fractures in childhood due to low energy rather than moderate or high energy. There were no changes in BMD Z-score during the follow-up period. The BMD deficit at follow-up was in boys with an index fracture verified with all advocated techniques. A childhood fracture in men was associated with low BMD and smaller bone size in young adulthood whereas the deficit in women did not reach statistical significance.