Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015)
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Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend.
Fracture incidence in 0–16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data.
A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed.
Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred.
Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.
KeywordsBone Population Paediatric Incidence Audit
The authors thank Mr. Dmitry Skarin for handling the queries to the EDIS database.
MJ drafted the initial manuscript. MJ, SN, NHH, PC, TR, FM and AS conceptualised the research design and interpreted the results. MJ and PC analysed, and SN and NHH reviewed statistical methods. KR, MLB, KS and AS contributed to data acquisition and interpretation. All authors critically evaluated and approved the final draft.
Mr. Mark Jenkins is supported by an Australian Government Research Training Program Scholarship. Dr. Nicolas H. Hart is supported by the Cancer Council of Western Australia Postdoctoral Research Fellowship.
Compliance with ethical standards
Ethics approval was obtained from the Princess Margaret Hospital Human Research Ethics Committee (GEKO ID: 12649) for analysis and subsequent publication of the de-identified data.
Conflicts of interest
- 10.Landin LA (1983) Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand 54(202 Suppl):1–109Google Scholar
- 26.Australian Bureau of Statistics (2016) 3101.0 - Australian demographic statistics, Dec 2015. Commonwealth of Australia: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3101.0Main+Features1Dec+2015. Accessed 27/12/2017
- 27.Swanson D, Siegel JS (2004) The methods and material of demography, 2nd edn. Academic Press, San DiegoGoogle Scholar
- 31.Ducher G, Naughton G, Daly R, Eser R, English R, Patchett A, Gravenmaker K, Seibel M, Javaid A, Cunningham R, Telford R, Bass S (2009) Overweight children have poor bone strength relative to body weight, placing them at greater risk for forearm fractures. J Sci Med Sport 12(Suppl):S6CrossRefGoogle Scholar
- 33.VicHealth (2016) Physical activity and sedentary behaviour: evidence summary. Victoria: Victoria State Government: https://www.vichealth.vic.gov.au/-/media/ResourceCentre/PublicationsandResources/Physical-activity/2016-Physical-Activity-and-Sedentary-Behaviour.pdf. Accessed 27/12/2017
- 35.Department of Health (2017) Health and wellbeing of children in Western Australia 2016, overview and trends. Government of Western Australia: http://ww2.health.wa.gov.au/~/media/Files/Corporate/Reports%20and%20publications/Population%20surveys/Health-and-Wellbeing-of-Children-in-Western-Australia-2016-Overview-and-Trends.pdf. Accessed 27/12/2017
- 36.Australian Bureau of Statistics (2012) 4156.0—sports and physical recreation: a statistical overview, Australia, 2012. Commonwealth of Australia: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4156.0. Accessed 27/12/2017