In last article we had a look at epidemiology of fractures in children. Here we would discuss specific fracture pattern and variables affecting them.
Age Variations
Some fractures are known to occur more in specific age groups. For example, fractures of the femur are most common in children ages 0 to 3 years of age. Similarly, fractures of supracondylar area in humerus are more common in second decade and peak is around 7 years of age.
Physeal fractures are more common near skeletal maturity.
Landin divided the fracture occurrence in children into these distinct patterns
Late Peak
Distal Forearm, Phalanges, Proximal Humerus [Late Peak around 14 years of age]
Bimodal
Clavicle, Femur, Tarsal-Metatarsal, Radius – Ulna, Diaphyses. Bimodal distribution of fractures around 5 years and 15 years
Rising
Ankle, Carpal Metacarpal rise linear with age
Early peak
Supracondylar peaks around 7 years
Irregular pattern
Tibia, Diaphyseal fractures showed irregular pattern.
Specific Fractures
Upper extremity are much more commonly fractured than the lower extremity. The most common area fractured is the distal radius. The next most common area reported is hand or elbow in different series.
The radius is the most commonly fractured long bone, followed by the humerus. In the lower extremity, the tibia is more commonly fractured than the femur.
The incidence of physeal injuries is reported as 14.5% – 27.6% . Approximately 2.9% of the fractures are said to be open fractures
Multiple fractures in children are uncommon and the incidence ranges from 1.7% – 9.7%.
The incidence of recurrent fractures in children is about 1% [Weak skeleton and other skeletal pathologies are contributory].
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