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Epidemiologic Dynamics Contributing to U.S. Pediatric Wrist Fractures
Neil Shah, MD; David Buzas, MD; Ephraim Zinberg, MD
Orthopaedic Surgery, Wayne State University, Taylor, MI

Introduction: In childhood, trauma to the distal upper extremity is frequent, and pediatric wrist fractures are commonly seen in the emergency department (ED). The purpose of this study was to explore and evaluate national epidemiologic trends and factors contributing to wrist fractures in children.

Methods: Over a 16-year period from January 1998 to December 2013, patients aged 0-17 years old with primary diagnosis of wrist fracture were identified and reviewed, as evaluated in U.S. EDs and chronicled by the National Electronic Injury Surveillance System (NEISS) database of the U.S. Consumer Product Safety Commission. Descriptive epidemiologic, bivariate, and chi-square analyses were conducted. Patients were categorized into age-defined subgroups (0-12 mo, 13-36 mo, 3-5 yrs, 6-10 yrs, and 11-17 yrs) and further stratified with regards to gender, race, location, and consumer product/activity associated with injury.

Results: There were 53,265 children evaluated in NEISS EDs (national estimate, 1,908,904) with wrist fractures from 1998-2013. Mean age was 10.9 (SD 3.8) years, with 64% male and 36% female. Most common locations of injury were place of recreation or sports (28%), home (23%), and school (13%). The top five consumer-product related injuries were associated with bicycles (10%), football (8%), playground activities (8%), basketball (6%), and soccer (5%). The highest associations were with beds or bedframes (19% of 0-12 mo), stairs or steps (14% of 13-36 mo), playgrounds (25% of 3-5 yrs and 15% of 6-10 yrs), and football (14% of 11-17 yrs). The greatest increase in fractures occurred between ages 0-12 and 13-36 months (1:3.8), with second-largest increase between ages 3-5 and 6-10 (1:2.2). There was a disproportionately higher number of females sustaining fractures in all groups under age 11, with increased males in the 11-17 group (18%, p<0.05).

Conclusions: It is essential to develop injury prevention and safety strategies as well as identify individual risk factors for fracture, including activity, gender, and key age transitions. Surveillance is imperative to advance our understanding of the epidemiologic basis for pediatric wrist fractures, and in the future may facilitate development of research prediction tools to anticipate or prevent injury.

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