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

Abstract

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.

Keywords: Boy; Epidemiology; Fractures; Girl; Time trends.

Fig. 1

The anatomical distribution of hand fractures in individuals aged < 16 during 2005–2006, presented as number of fractures with proportion of all hand fractures in brackets. The sums for each ray 1 to 5 are presented on the top row and the sums of distal, intermediary and proximal phalangeal fractures, metacarpal fractures, and carpal fractures on the left

Fig. 2

Age-specific incidence rates of all types of hand fractures, fractures of the phalanges, fractures of the metacarpals/carpal bones, and fractures of the scaphoid bone in boys and girls during 2005–2006, presented as number of fractures /100,000 person years

Fig. 3

Crude and age-adjusted gender-specific incidence rates of hand fractures during six evaluated periods from 1950/1955 to 2005–2006, presented as number of fractures /100,000 person years. The included periods are indicated with horizontal thick lines from period start to period end while the evaluated years are indicated by thin crosses. Comparisons between different periods are provided as rate ratios (RR) with 95% confidence intervals (95% CI). Horizontal arrows above and below the RR indicate the compared periods

Fig. 4

The age-specific incidence rate of hand fractures in boys and in girls during the three periods: 1950/1955 (study start), 1976–1979 (middle of study period), and 2005–2006 (study end), presented as incidences per 2-year age class /100,000 person years