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

Clinical characteristics and distribution of paediatric hand fractures at a tertiary hospital in South China: a retrospective analysis

“…Overall, these studies found that males are more vulnerable than females, older children are more likely to be injured, and the fifth finger and proximal phalanx are more frequently involved, which is similar to our results. In addition, eight out of nine studies reported a higher incidence of sports-related injuries than our series [3–5,7,9,18–20]; and Mirdad [8] reported that crushing is the most common aetiology of PHF. Different fracture characteristics among the studies are likely to be influenced by the different ages and types of activities, including sports, of patients.…”

“…We compared nine published studies from other countries according to age, mechanism of injury and fracture pattern [3][4][5][7][8][9][18][19][20] (Table 3). Overall, these studies found that males are more vulnerable than females, older children are more likely to be injured, and the fifth finger and proximal phalanx are more frequently involved, which is similar to our results.…”

The Diagnosis and Treatment of Pediatric Closed Digital Arterial Injury with A Proximal Phalangeal Fracture

“…Open traumatic injuries are usually associated with crush, clean cuts, and avulsion injuries. Generally, displaced bone fractures are managed by displacement reduction and bone fixation 1) while paying attention to the vascularization of the finger. Clinical findings, such as cyanosis or pallor, decreased capillary refill, and numbness, indicate a possible decrease in blood supply to the injured finger owing to disturbances in flow from both the radial and ulnar digital arteries.…”