The epidemiology of fractures in children
ABSTRACT A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.
- SourceAvailable from: Britt van Erven[Show abstract] [Hide abstract]
ABSTRACT: Decreased bone mass is frequently encountered in classic galactosemia, an inborn error of galactose metabolism. This decrease is most prominent in adults, but is already seen in prepubertal children with increased risk of osteoporosis and fractures later in life. Therefore, bone health in patients with classic galactosemia is increasingly monitored. Although the pathophysiological mechanism is still not fully understood, several factors could negatively affect bone metabolism in this disease. Patients are at risk of nutritional deficiencies due to the galactose-restricted diet. Primary ovarian insufficiency (POI) in female patients also contributes to decreased bone mass. Furthermore, patients with classic galactosemia might be less physically active due to motor or neurological impairments. A disease-specific intrinsic abnormality has been suggested as well. This revised proposal is an update of the 2007 recommendations. In this current approach, we advise comprehensive dietary evaluation, optimization of calcium intake if needed, monitoring and if necessary supplementation of vitamin D, hormonal status evaluation and hormone replacement therapy (HRT) consideration, as well as a regular exercise and assessment of skeletal deformities and clinically significant fractures. We propose bone mineral density (BMD) assessment by serial DXA scans of the lumbar spine, femoral neck, and total hip in adults and lumbar spine and total body less head (TBLH) in children.
Article: Tibial fractures in children[Show abstract] [Hide abstract]
ABSTRACT: Background Tibial fracture is the third most common long-bone fracture in children. Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results. Methods 94 children (64 boys) were treated for a tibial fracture in Aurora City Hospital during the period 1980–89 but 20 could not be included in the study. 58 of the remaining 74 patients returned a written questionnaire and 45 attended a follow-up examination at mean 27 (23–32) years after the fracture. Results 89 children had been treated by manipulation under anesthesia and cast-immobilization, 4 by skeletal traction, and 1 with pin fixation. 41 fractures had been re-manipulated. The mean length of hospital stay was 5 (1–26) days. Primary complications were recorded in 5 children. The childrens’ memories of treatment were positive in two-thirds of cases. The mean subjective VAS score (range 0–10) for function appearance was 9. Leg-length discrepancy (5–10 mm) was found clinically in 10 of 45 subjects and rotational deformities exceeding 20° in 4. None of the subjects walked with a limp. None had axial malalignment exceeding 10°. Osteoarthritis of the hip and/or knee was seen in radiographs from 2 subjects. Interpretation The long-term outcome of tibial fractures in children treated non-operatively is generally good.Acta Orthopaedica 04/2014; 85(5). DOI:10.3109/17453674.2014.916489 · 2.45 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES: To identify the type and frequency of interventions used by physiotherapists in rehabilitating patients after a distal radial fracture; and, to examine whether any patient or therapist characteristics had an effect on the frequency of interventions administered. DESIGN: Observational study. SETTING: Four metropolitan outpatient physiotherapy departments. PARTICIPANTS: 14 physiotherapists reported on 160 distal radial fracture consultations. MAIN OUTCOME MEASURES: Physiotherapists recorded the type of interventions and time spent administering interventions during each distal radial fracture consultation. RESULTS: A combined site response rate of 70% was achieved (160/204). The most common interventions were exercise (155/160), advice (144/160), passive joint mobilisation (88/160) and massage (60/160). Patient characteristics and physiotherapist experience had little impact on the type and frequency of interventions reported by physiotherapists. CONCLUSIONS: Exercise and advice were the most frequently administered interventions for patients after a distal radial fracture irrespective of physiotherapist or patient factors. During rehabilitation, these interventions aim to restore wrist mobility and are consistent with both fracture management principles and a self management approach. Due to the routine use of exercise and advice there is a need for further research to provide high quality evidence that these interventions improve outcomes in patients after a distal radial fracture.Physiotherapy 11/2012; 99(3). DOI:10.1016/j.physio.2012.09.003 · 2.11 Impact Factor