How common are refractures in childhood?

Abstract

AimsThe aim of this study was to describe the incidence of refractures among children, following fractures of all long bones, and to identify when the risk of refracture decreases.MethodsAll patients aged under 16 years with a fracture that had occurred in a bone with ongoing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the primary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones.ResultsOf 40,090 primary fractures, 348 children (0.88%) sustained a refracture in the same long bone segment. The diaphyseal forearm was the long bone segment most commonly affected by refractures (n = 140; 3.4%). The median time to refracture was 147 days (interquartile range 82 to 253) in all segments of the long bones combined. The majority of the refractures occurred in boys (n = 236; 67%), and the left side was the most common side to refracture (n = 220; 62%). The data in this study suggest that the risk of refracture decreases after 180 days in the diaphyseal forearm, after 90 days in the distal forearm, and after 135 days in the diaphyseal tibia.ConclusionRefractures in children are rare. However, different fractured segments run a different threat of refracture, with the highest risk associated with diaphyseal forearm fractures. The data in this study imply that children who have sustained a distal forearm fracture should avoid hazardous activities for three months, while children with a diaphyseal forearm fracture should avoid these activities for six months, and for four and a half months if they have sustained a diaphyseal tibia fracture.Cite this article: Bone Joint J 2023;105-B(8):928–934.

Children’s orthopaedics

“…Research from a team in Gothenburg (Sweden) aimed to provide insight into the incidence and timing of refractures, which can then be valuable for advising children and their parents on when it is safe to resume normal activities after a fracture. 2 The study is a ‘big data’ study, and its analysis is based on data extracted from the national Swedish Fracture Register (SFR). The researchers examined data from May 2015 to December 2020 for patients under the age of 16 years with fractures in immature bones.…”