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ID: 58 (Conflict of Interest: K)

Versorgungspflichtige Unterarmfrakturen bei Kindern und Jugendlichen – eine epidemiologische Studie über die letzten 7 Jahre

D.Sauter, P.Till, M.Schüler
Kantonsspital Münsterlingen, Münsterlingen

Einleitung

The incidence of fractures in children and adolescents in Central Europe is 21-25/1000 per year, whereby the data cited is primarily from the end of the 20th century. Joeris et al. (BMC Pediatrics, 2014) examined the fractures of long bones in a cohort study (from 2009 to 2011) at two Swiss children's hospitals. It was found that the most common fractures were of the forearm with 59%. There is, however, no  precise classification of these fractures or detailed information on the aetiology. It is also unclear how often the forearm fractures had to be treated surgically.

Material und Methoden

As a retrospective study, we analyzed all forearm fractures in children/adolescents (up to 16y) who were treated at our trauma clinic from 2010 to 2016. As the only hospital with a paediatric and neonatal department in the region, referrals for surgical care were made mainly to our clinic, the servide area encompassing approx. 26,400 children/adolescents.

Ergebnisse

Incidence

During the 7 year period, 738 (437m, 301f) forearm fractures were diagnosed. Of these, 296 (40%) fractures (190m, 106f) had to be either set using closed reduction or osteosynthesis (K-wires, TENS or plate). This corresponds to an incidence of forearm fractures requiring treatment of 20/10,000 per year for boys and 12/10,000 for girls.

Osteosynthesis

While 40% of the fractures (under anesthesia) were set using only closed reduction in 2010, this percentage continued to drop to 21% in 2016. The percentage of osteosynthesis procedures increased accordingly.

Classification

Among the boys, 74% were predominantly distal radius fractures, followed by diaphyseal fractures with 21% and proximal fractures with 5%. Among the girls, there were 63% distal radius fractures and 28% diaphyseal fractures. Proximal fractures at 9% were almost twice as common as in boys.

Analysis of subgroups by age

In recent years, there has been a constant percentage of 5-6% in the 0-4 years age range among both boys and girls. The highest percentage is of boys between the ages of 10 and 16 who form about 35% of all those injured. In the last two years of the observation period, a trend has become apparent which shows that more young people between 10 and 16 need to have surgery. On the other hand, the injuries in the 5-9 years age group have declined.

Aetiology

The accident sources show an age- and gender-specific distribution. For example, bicycle accidents are found predominantly in the 10-16 years age group, with 20% for both boys and girls. Sports injuries are more common among boys and start at the age of 5-9 years with 27.5% and rise to 48% between the ages of 10 and 16 years. Among infants up to the age of 4 years, 56% of the boys were injured in the playground, as compared with only 27% of the girls. 15% of the fractures in the 10-16 years age group for girls were the result of a fall from a horse.

Annual distribution

There is a nearly uniform distribution throughout the year for the girls. For the boys, there are clusters of occurrence in the winter months Dec. to Feb., as well as in the summer.

Schlussfolgerung

A prevailing incidence of forearm fractures requiring surgical treatment could be calculated. The high proportion of surgical cases (40%) can be explained by the fact that most children/adolescents have already been externally diagnosed and then referred for surgery. Non-dislocated fractures are treated predominantly by resident paediatricians or family doctors. This means that our overall regional incidence of forearm fractures remains unclear, especially regarding changes that may have occurred in recent years.