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

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.

Keywords: Boys; Children; Epidemiology; Etiology; Fractures; Girls; Hand; Joinpoint; Time trends.

Fig. 1

The anatomical distribution of hand fractures in children 0–15 years, in Malmö, Sweden, in 2014–2016, presented as numbers with proportions of all hand fractures in brackets. The sum for each ray (metacarpal and phalangeal fractures) is presented above the respective ray and the sums of phalangeal fractures (distal, middle, and proximal phalangeal fractures), metacarpal fractures, and carpal fractures are presented on the left

Fig. 2

Hand fracture incidence per 100,000 person-years (divided into all hand fractures, phalangeal fractures, metacarpal/carpal fractures, and scaphoid fractures) in boys (a) and girls (b) aged 0–15 years (combined in 2-years age classes) in Malmö, Sweden, in 2014–2016

Fig. 3

Unadjusted (a) and age-adjusted (b) hand fracture incidence per 100,000 in Malmö, Sweden, in boys and girls < 16 years of age during the years 2014–2016 in comparison with previous examined periods; 1950/1955, 1960/1965, 1970/1975–1979, 1993–1994, and 2005–2006. The thick lines show the different periods studied and the thin vertical lines within indicate individual study years included in that period. Arrows indicate the period compared with 2014–2016, and the number above shows its associated incident rate ratio (IRR) with 95% confidence interval (95% CI)

Fig. 4

Hand fracture incidence per 100,000 person-years in boys (a) and girls (b) separately aged 0–15 years (combined in 2-years age classes) in Malmö, Sweden, in 1950/1955, 2005–2006, and 2014–2016

Fig. 5

Time trends in hand fractures in the period 1950–2016 calculated by joinpoint regression. Age-adjusted hand fracture incidence per 100,000 person-years in Malmö, Sweden, in boys and girls < 16 years. Data are presented as annual percent changes (APC) with 95% confidence interval (95% CI) to describe uncertainty