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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 189-191

Diaphyseal fractures in pediatric age group in rural area: A demographic study


Department of Orthopedics, Jawaharlal Nehru Medical College and AVBRH, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Submission11-Jul-2019
Date of Decision30-Jul-2019
Date of Acceptance20-Aug-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Nareshkumar Dhaniwala
Department of Orthopedics, Jawaharlal Nehru Medical College and AVBRH, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha - 442 107, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_79_19

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  Abstract 


Introduction: Fractures in children are a common occurrence. Fractures have a considerable impact on daily living and activities of affected children and thus are an important topic of public health. The present study aims to study the demographic aspects of diaphyseal fractures in children. Materials and Methods: This is a prospective study conducted in a tertiary care rural hospital in Central India on children in the age group of 3–15 years between June 2017 and April 2019. A total of 38 fractures in 25 children were included in the study. Results: The incidence of fractures was found more common in boys (60%). Most of the fractures were seen in the age group of 11–15 years (68%). Fall from level ground while playing was reported to be the most common mode of trauma (56%), followed by road traffic accident. Twenty-eight percent of the patients presented to the hospital on the day of trauma. Among the bones fractured, both bone forearms were the most common (52%). Overall, left-sided fractures were more common (56%) than right sided (44%). Middle one-third shaft was the most commonly fractured level.Conclusions: Both bone forearms are the most common diaphyseal fractures in children and middle one-third is the most common level. Injury prevention programs will help in decreasing the incidence and morbidity associated with pediatric fractures.

Keywords: Children, demography, diaphyseal, fractures


How to cite this article:
Reddy S, Dhaniwala N. Diaphyseal fractures in pediatric age group in rural area: A demographic study. J Datta Meghe Inst Med Sci Univ 2019;14:189-91

How to cite this URL:
Reddy S, Dhaniwala N. Diaphyseal fractures in pediatric age group in rural area: A demographic study. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Sep 28];14:189-91. Available from: http://www.journaldmims.com/text.asp?2019/14/3/189/283601




  Introduction Top


Child injuries have become a global public health concern. As per the WHO, it is estimated that over 630,000 children under the age of 15 years were killed by an injury. It is also estimated that for every child who dies, several thousands of children have nonfatal injuries and live on with varying degrees of disability.[1] It is estimated that 10%–25% of pediatric injuries are fractures.[2] Fractures have a considerable impact on daily living and activities of affected children and thus are an important topic of public health. Fractures are found to be more common in boys. Boys have a lifetime risk of sustaining a fracture as high as 64%, whereas for girls, it is 40%.[3]

The overall incidence rate of fractures in children is 180.1 per 10,000 children. Fractures sustained in children mostly heal without loss of function but contribute to significantly associated costs for the child and family, including time away from school and reduced activities for a considerable time.[4] Most of the studies have focused on all the fractures in children, irrespective of its location in the diaphyseal/metaphyseal area. The present study aims to evaluate the demography of only the diaphyseal fractures of major pediatric long bones, which underwent surgical management.


  Materials and Methods Top


This is a prospective study conducted in a tertiary care rural hospital in Central India on children in the age group of 3–15 years between June 2017 and April 2019. A total of 38 fractures in 25 children were included in the study. Ethical clearance was obtained from the institutional ethics committee. Detailed history was noted, and physical examination and radiographs were obtained. All the findings were entered in a set pro forma. Data were analyzed to study various epidemiological parameters.


  Observation and Results Top


In this study, there were 15 boys (60%) and 10 girls (40%). Most of the fractures were seen in the age group of 11–15 years (68%). Fall from level ground while playing was the most common mode of trauma (56%), followed by road traffic accident, fall from height, and blunt trauma, in that order. Twenty-eight percent of the patients presented to the hospital on the same day of trauma. Fifty-six percent presented between 1 and 5 days, 12% between 6 and 10 days, and 4% after 10 days. Among the bones fractured, both bone forearms were the most commonly fractured bones (52%), followed by femur (24%), tibia (20%), and ulna alone (4%), as shown in [Figure 1]. Overall, left-sided fractures were more common (56%) than right sided (44%). However, in the lower limb fracture group alone, right-sided fractures were more common. Middle one-third level was the most commonly fractured level (61%), followed by lower one-third and upper one-third, as shown in [Figure 2]. The most common type of fracture was transverse (81%), followed by oblique, spiral, segmental, and comminuted.
Figure 1: Distribution of fractures

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Figure 2: Level of fracture

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  Discussion Top


The present study revealed that boys are more commonly injured than girls. This is consistent with studies conducted by Tandon et al.,[5] Singh et al.,[6] Babu et al.,[7] and Kundal et al.[8] There are several likely reasons for this. In rural India, boys are given more freedom to play and roam outside the house. Besides, boys start working at an early age. On the other hand, girls tend to stick to household work. As a result, boys get more exposed to potentially risky environment compared to girls.

As per a study conducted by Joeris et al., falls (27%) are the leading cause of fractures in children. Accidents occurring during leisure activities (25%) also formed a major cause of fractures in children.[3] In our study, fall from level ground while playing was found to be the most common mode of sustaining injury, accounting for 56% fractures. This was followed by road traffic accidents. However, Babu et al.[7] and Kundal et al.[8] found road traffic accident to be the most common cause of pediatric fractures in India. This could be attributed to the fact that our study was based in a rural scenario, where the use of motorized vehicles is less compared to cities.

The incidence of fractures was more in the children of the age group of 11–15 years (68%). Singh et al.[6] and Kundal et al.[8] found similar results in their studies. Again, this may be due to the fact that the physical activity of children increases with age.

Tandon et al.[5] noted the most commonly encountered site of fractures in children as the distal end of radius, followed by elbow, forearm shaft, and tibial shaft.[5] However, in our study, both bone forearms were the most common (52%), followed by femur (24%), tibia (20%), and ulna alone (4%).

Twelve percent of the children were brought to the hospital between 6 and 10 days after trauma, whereas 4% were brought after 10 days. Most of the children were initially taken to local quacks. This gives us an insight about the lack of health-care awareness in villages.

The present study includes only diaphyseal fractures of long bones in children. Therefore, our conclusions are varying from previous studies.

Currently, there is a dearth of injury prevention programs for children, especially in villages. There is a need to increase awareness among the villagers and children and educate them about road safety measures. Playgrounds and schools should be made safer, and children should be under supervision to minimize falls while playing. Villagers should also be taught regarding the importance of early health-care facility access. These measures will help in decreasing the incidence and morbidity associated with pediatric fractures.


  Conclusions Top


Based on the present study, we conclude that:

  1. Fall from level ground is the most common cause of diaphyseal fractures in pediatric age group, followed by road traffic accidents
  2. Both bone forearms are the most common diaphyseal fractures in children
  3. Taking the level of fracture into consideration, middle one-third fractures are noted to be the most common.


Limitations

The limitation of our study is the small sample size as only surgically managed cases were included. Larger study including all modes of management may bring different conclusions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. WHO – Violence and Injury Prevention. World Health Organization; 2016. Available from: https://www.who.int/violence_injury_prevention/child/injury/en/. [Last accessed on 2016 Apr 28].  Back to cited text no. 1
    
2.
Landin LA. Epidemiology of children's fractures. J Pediatr Orthop B 1997;6:79-83.  Back to cited text no. 2
    
3.
Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures – A retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 2014;14:314.  Back to cited text no. 3
    
4.
Randsborg PH, Gulbrandsen P, Saltytė Benth J, Sivertsen EA, Hammer OL, Fuglesang HF, et al. Fractures in children: Epidemiology and activity-specific fracture rates. J Bone Joint Surg Am 2013;95:e42.  Back to cited text no. 4
    
5.
Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.  Back to cited text no. 5
    
6.
Singh O, Gupta S, Din Darokhan MA, Ahmad S, Charak SS, Sen A. Epidemiology of pediatric musculoskeletal injuries and their pattern in a tertiary care center of North India. Indian J Orthop 2018;52:449-53.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Babu A, Rattan A, Ranjan P, Singhal M, Gupta A, Kumar S, et al. Are falls more common than road traffic accidents in pediatric trauma? Experience from a Level 1 trauma centre in New Delhi, India. Chin J Traumatol 2016;19:75-8.  Back to cited text no. 7
    
8.
Kundal VK, Debnath PR, Sen A. Epidemiology of pediatric trauma and its pattern in urban India: A tertiary care hospital-based experience. J Indian Assoc Pediatr Surg 2017;22:33-7.  Back to cited text no. 8
[PUBMED]  [Full text]  


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