The risk of non-union per fracture in children

Non-union in children is considered a rare but real complication of fracture management; however there is no information available in the literature regarding its incidence. The aim of this work was to investigate the incidence of fractures and non-union in children for different anatomical regions/age groups, and for the first time to publish data regarding the rate of non-union per fracture in children in a large population.

Prospective data for all hospital admissions for paediatric fractures and paediatric fracture non-union in Scotland between 2005 and 2010 was obtained. Regional data for total paediatric fracture numbers was also available enabling total fracture numbers and non-union incidence at a national level to be calculated.

There were 180 non-unions in the 0-14 year olds and 242 non-unions in 15-19 year olds recorded over 5 years in a population of 1.2 million children (0-19 years). The number of fractures during this time period for the same age groups were 92,200 and 68,900 respectively. The risk of fracture increased steadily with age; it was greater in boys than girls and far higher in the upper than lower limb. The overall rate of non-union per fracture was 0.2 % in those 14 years and younger and 0.35 % in the 15-19 year olds. Non-union was highest in the male 15-19 year olds at 0.45 % of all fractures. The risk of non-union was far greater in the lower limb fractures than in the upper limb fractures throughout childhood until the age of 15 where the upper limb NU rate per fracture exceeded that of the lower limb.

The calculated risk of non-union per fracture is low throughout childhood with a risk of approximately 1 in 500 or less per fracture in boys aged under 14 years and in girls of all ages, however NU increases to approximately 1 in 200 fractures for the older teenage (15-19 years) boys.