Fractures in children
C U Nwadinigwe1, C O Ihezie, E C Iyidiobi
1National Orthopaedic Hospital, Enugu, Nigeria.
Insights
Paediatric fractures are common in our setting, often resulting from road traffic accidents and falls. Early intervention and prevention strategies are crucial to reduce severe complications, particularly those arising from traditional bone setters.
Area of Science:
- Orthopaedic surgery
- Paediatric trauma care
Background:
- Infections and malnutrition dominate childhood diseases, overshadowing paediatric trauma.
- Paediatric fractures receive limited attention and advocacy.
- This study reviews the pattern of paediatric fractures in a local setting.
Purpose of the Study:
- To describe the epidemiology of paediatric fractures.
- To identify common causes and fracture sites in children.
- To analyze treatment modalities and outcomes.
Main Methods:
- Retrospective review of medical records of children under 14 years admitted for major trauma.
- Data collected from January 1999 to December 2003.
- Incomplete records were excluded.
Main Results:
- Road traffic accidents (51%) and falls from height (41.8%) were primary causes.
- Femoral shaft fractures were most common (33.7%), followed by humerus and distal radius fractures.
- Delayed presentation from traditional bone setters led to complications like compartment syndrome and gangrene.
Conclusions:
- Paediatric fractures are prevalent and associated with significant morbidity, often due to traditional bone setter interference.
- These injuries are preventable through targeted strategies for parents, children, and road users.
- Reducing the burden of paediatric fractures is vital, especially in developing countries.
Background:
The burden of diseases in children in our environment is dominated by infections and malnutrition; paediatric trauma has low advocacy and as such is given scant attention. The aim of this study is to review and describe the pattern of paediatric fractures in our local setting.
Method:
A retrospective review of all the medical records of children below the age of fourteen years who were admitted to our center on account of major trauma between January 1999 and December 2003 was done. Those with incomplete records were excluded.
Results:
The patients ranged in age from 1 +/-13 years with mean of 6.7 +/- 2.9 years. They were mostly males 60 (61.2%) and females 38 (38.8%). The causes of the accidents were diverse. Road traffic accidents were most common 47(51%). A great number of these resulted from unguarded children hit by motor vehicles while crossing the road 33 (36.7%). Forty-one (41.8%) patients fell from various heights. Of these number thirty (30.6%) fell while playing. Most fractures were close 70 (71.4%) while 25 (25.5%) were open fractures and 3 (3.1%) pathological fractures. The most common site of injury was the femoral shaft 33.7%; this was followed by fractures of the supracondylar region of the humerus 17.3%, distal radius 15.3% and tibialfibula 15.3%. More than half of the patients 58 (59.2%) presented fresh to our hospital, while 27 (27.6%) presented initially to traditional bonesetter (TBS) and 13 (13.3%) were referred from private practitioners. Of those twenty-seven patients from the TBS, seven came with compartment syndrome and three had frank gangrene. Most of the patients were managed conservatively. Preliminary traction followed by plaster of Paris (POP) application in 36 (36.7%), and manipulation under anaesthesia (M.U.A) and POP (30.6%), were common definitive treatments given. Sixteen patients (16.3%) had open reduction and internal fixation. Acute compartment syndrome 7 (7.1%) and frank gangrene 3 (3.1%) were the commonest complications and were due to late referral by traditional bonesetters.
Conclusion:
In our environment, fractures in children are common and are frequently associated with morbidities due to interference by traditional bonesetters. These injuries are highly preventable and paediatric trauma prevention strategies directed at parents, children as well as other road users would help to reduce the burden of such fractures especially in the developing countries where the burden of other childhood diseases obscures trauma care.
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Assessment:
1. Clinical Evaluation:
History: