Karen Rosendahl1,2, Ramona Myklebust3, Kjersti Foros Ulriksen4, A Nøttveit5, Pernille Eide6, Åsmund Djuve7, Christina Brudvik5,8. 1. Faculty of Health Sciences, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway. karen.rosendahl@unn.no. 2. Section of Paediatric Radiology, University Hospital North Norway, Pb 100, 9038, Tromsø, Norway. karen.rosendahl@unn.no. 3. Norheimsund Medical Center, Norheimsund, Norway. 4. Triangel Medical Center, Stjørdal, Norway. 5. Bergen Accident and Emergency Department, Bergen, Norway. 6. Knarvik Medical Center, Knarvik, Norway. 7. Harstad Hospital, Harstad, Norway. 8. Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway.
Abstract
BACKGROUND: Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children. METHODS: This retrospective, cross-sectional study includes all children aged 0-2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist. RESULTS: In total 408 children (212 male), 3-23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12-24 months of age. More than half of the fractures (53.1%) were seen in children aged 18-23 months, while none was found in those under 7 months of age. The youngest age group had mostly femur and tibia fractures, the oldest mostly forearm fractures (n = 55, 33.9%), followed by tibia fractures (21.6%) and fractures to the clavicle (14.8%). The reported mechanisms for the 162 fractures were fall from a chair/bed/table (41.4%), fall from own height (18.5%) or crush injury (15.4%). In 8 of 162 (4.9%) fractures, the history was clearly inconsistent and suspicious of non-accidental injury (NAI). CONCLUSION: Injuries and fractures in young children in general, and non-ambulant children in particular, are rare and should be thoroughly assessed for NAI. LEVEL OF EVIDENCE: Retrospective, population based cross-sectional study. Level 3.
BACKGROUND:Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children. METHODS: This retrospective, cross-sectional study includes all children aged 0-2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist. RESULTS: In total 408 children (212 male), 3-23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12-24 months of age. More than half of the fractures (53.1%) were seen in children aged 18-23 months, while none was found in those under 7 months of age. The youngest age group had mostly femur and tibia fractures, the oldest mostly forearm fractures (n = 55, 33.9%), followed by tibia fractures (21.6%) and fractures to the clavicle (14.8%). The reported mechanisms for the 162 fractures were fall from a chair/bed/table (41.4%), fall from own height (18.5%) or crush injury (15.4%). In 8 of 162 (4.9%) fractures, the history was clearly inconsistent and suspicious of non-accidental injury (NAI). CONCLUSION:Injuries and fractures in young children in general, and non-ambulant children in particular, are rare and should be thoroughly assessed for NAI. LEVEL OF EVIDENCE: Retrospective, population based cross-sectional study. Level 3.
Authors: Nicholas M P Clarke; Fenella R M Shelton; Colm C Taylor; Tajjali Khan; Senbaga Needhirajan Journal: Injury Date: 2011-09-19 Impact factor: 2.586
Authors: Vasileios Lempesis; Björn E Rosengren; Jan-Åke Nilsson; Lennart Landin; Carl Johan Tiderius; Magnus K Karlsson Journal: Acta Orthop Date: 2017-05-31 Impact factor: 3.717