Epidemiology and etiology of childhood fractures in southern Sweden

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

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Sammanfattning

Background: As much as 40–50% of children are expected to sustain fractures during growth. A childhood fracture is alsoassociated with high risk of fractures in adult life. Previous research has shown that fracture incidence has not been stable andsome studies suggest that this has also continued during recent decades.Aims: The aim of this thesis was therefore to describe fracture epidemiology and etiology in children in Malmö, Sweden, in2005–2006. We also wanted to make historical comparisons, to be able to estimate fracture time trends in the pediatric citypopulation, and investigate time trends in the epidemiology of pediatric distal forearm fractures in the county of Skåne.Methods: In papers I, III, IV we identified fractures in children (age<16 years) in the city of Malmö during the years 2005–2006 through the diagnosis registry, medical charts and radiographic archives of the hospital. We then calculated crude and agestandardizedfracture rates and made comparisons with previously collected and published pediatric fracture data from 12sample years during the period 1950 to 1994. In Paper II we used data from the SHR, an official database of in- and outpatientcare episodes in the county of Skåne, Sweden, to ascertain distal forearm fractures in children (<17 years of age) that occurredbetween 1999 and 2010.Results: In paper I, we found that the rate of pediatric fractures in the city of Malmö in 2005–2006 was 1832 per 105 patientyears (2359 in boys and 1276 in girls). Fractures were more common in boys than in girls (age-adjusted fracture RR 1.8; 95%CI 1.6 to 2.1) and the most common fracture types were the distal forearm (31%), the phalanges of the digits (15%), and themetacarpals (10%). Fractures in which the etiology could be determined occurred most often during sports, playing or in traffic.The age- and gender-adjusted incidence in children in 2005–2006 did not differ significantly from 1993–1994 (RR 0.9; 95% CI0.8 to 1.03).The age-adjusted incidence in girls was however lower (RR 0.8; 95% CI 0.7 to 0.99) with no evident change inboys (RR 1.0; 95% CI 0.9 to 1.1). In paper II, the rate of pediatric distal forearm fractures in the county of Skåne, Sweden,1999–2010 was 634 per 105 person years (750 in boys and 512 in girls), with a significant increase of 2.2% (95% CI 1.7 to 2.6)per 105 persons per year during the period of observation ((RR 2.0%; 95% CI: 1.5 to 2.6) in boys and (RR 2.4%: 95% CI: 1.7 to3.1) in girls). In paper III, we found that the pediatric distal forearm fracture incidence in the city of Malmö in 2005–2006 was564 per 105 person years (719 in boys and 401 in girls). The age- and gender-adjusted incidence in children in 2005–2006 didnot differ significantly from 1993–1994 (RR 1.1; 95% CI 0.9 to 1.3), neither in boys (RR 1.2; 95% CI 0.98 to 1.6) nor in girls(RR 0.8; 95% CI 0.6 to 1.1). In paper IV, we found that the pediatric hand fracture incidence in the city of Malmö in 2005–2006was 448 per 105 person years (639 in boys and 247 in girls). The age- and gender-adjusted hand fracture incidence in children in2005–2006 did not differ significantly from 1993–1994 (RR 1.0; 95% CI 0.7 to 1.1), neither in girls (RR 0.8; 95% CI 0.5 to 1.1)nor in boys (RR 0.9; 95% CI 0.7 to 1.2)Conclusion: The incidence of pediatric fractures in Malmö in 2005–2006, was higher in boys than in girls and the overallincidence in children was no different in 2005–2006 compared to 1993–1994. The incidence of pediatric distal forearm fractures
Originalspråksvenska
KvalifikationDoktor
Tilldelande institution
  • Ortopedi - klinisk och molekylär osteoporosforskning
Handledare
  • Karlsson, Magnus, handledare
  • Rosengren, Björn, handledare
  • Landin, Lennart, handledare
Tilldelningsdatum2018 maj 11
UtgivningsortLund
Förlag
ISBN (tryckt)978-91-7619-613-7
StatusPublished - 2018

Bibliografisk information

Defence details
Date: 2018-05-11
Time: 09:00
Place: Ortopedens Föreläsningssal, Inga Marie Nilssons gata 22, Malmö
External reviewer(s)
Name: Sayed-Noor, Arkan
Title: Associate Professor
Affiliation: Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska Institutet
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ISSN: 1652-8220
Lund University, Faculty of Medicine Doctoral Dissertation Series 2018:46

Ämnesklassifikation (UKÄ)

  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi

Nyckelord

  • CHILDREN
  • Boys
  • Etiology
  • Girls
  • Epidemiology
  • fractures
  • trends
  • distal forearm
  • hand
  • phalanges
  • metacarpals

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