Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016

Abstract Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9–1.2 and girls IRR 1.1, 95% CI: 0.9–1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7–1.2) and girls (APC +0.6%, 95% CI: 0.3–0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.

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Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02380-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Erika Bergman ◽

Vasileios Lempesis ◽

Lars Jehpsson ◽

Björn E. Rosengren ◽

Magnus K. Karlsson

Keyword(s):

Time Trends ◽

Fracture Incidence ◽

Entire Period ◽

Published Data ◽

Health Care Planning ◽

Level Of Evidence ◽

Hand Fractures ◽

Hand Fracture ◽

Phalangeal Fractures ◽

Adjusted Incidence

Abstract Background The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016. Patients and methods The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI. Results In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1. Conclusions Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016. Level of evidence III

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

Journal of Wrist Surgery ◽

10.1055/s-0039-1692471 ◽

2019 ◽

Vol 08 (06) ◽

pp. 463-469 ◽

Cited By ~ 2

Author(s):

Vasileios Lempesis ◽

Daniel Jerrhag ◽

Björn E. Rosengren ◽

Lennart Landin ◽

Carl Johan Tiderius ◽

...

Keyword(s):

Time Trends ◽

Traffic Accidents ◽

Sports Injuries ◽

Forearm Fracture ◽

Fracture Incidence ◽

Patient Specific ◽

Distal Forearm ◽

Distal Forearm Fracture ◽

Age And Gender ◽

And Gender

Abstract 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.

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FRI0479 TRENDS IN LOW TRAUMA DISTAL FOREARM FRACTURE INCIDENCE IN WOMEN AND MEN OVER 1995-2015 IN OLMSTED COUNTY, MINNESOTA, USA

10.1136/annrheumdis-2019-eular.7101 ◽

2019 ◽

Author(s):

Delamo Bekele ◽

Elizabeth Atkinson ◽

Shreyasee Amin

Keyword(s):

Forearm Fracture ◽

Fracture Incidence ◽

Distal Forearm ◽

Olmsted County ◽

Distal Forearm Fracture

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X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

Journal of Wrist Surgery ◽

10.1055/s-0040-1721139 ◽

2020 ◽

Author(s):

Henrik Johan Sjølander ◽

Sune Jauffred ◽

Michael Brix ◽

Per H. Gundtoft

Keyword(s):

Diagnostic Imaging ◽

Forearm Fracture ◽

Minimal Risk ◽

Distal Forearm ◽

Forearm Fractures ◽

Distal Forearm Fracture ◽

Standard Regimen ◽

Prolonged Immobilization ◽

Distal Forearm Fractures

Abstract Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

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