Temporal variation in pediatric supracondylar humerus fractures requiring surgical intervention

Changes in pediatric fracture patterns presenting to US emergency departments before, during, and after the COVID-19 pandemic

The purpose of this study was to analyze the demographics of pediatric fracture patients before, during, and after the COVID pandemic using US national emergency department (ED) data. The National Electronic Injury Surveillance System (NEISS) data for the years 2018 through 2021 was extracted for those <16 years of age, and organized into 24 consecutive bimonthly groups. There was a decrease in the number of ED visits for fractures in 2020 and returned to pre-COVID levels by March/April of 2021, except for small hospitals which demonstrated an earlier rebound beginning in late 2020. During the pandemic the incident locale was more frequently the home and less at schools/sporting venues, which returned to pre-COVID levels by March/April 2021. The proportion of those not discharged from the ED increases from March/April 2020 to March/April 2021. The median age was 8.8, 9.0, 8.2, and 8.7 years respectively for the years 2018, 2019, 2020, and 2021. Early in the pandemic there were more radius/ulna and fewer finger fractures and more tibia/fibula and fewer toe fractures; these changes did not return to pre-COVID percentages until the end of 2021. Fractures associated with bicycles and trampolines remained stable throughout the pandemic, those due to skateboards increased, and those due to playground and sporting activities decreased, with varying times of return to pre-COVID levels. In conclusion pediatric fracture patterns during the COVID-19 pandemic demonstrated many changes; most returned to baseline patterns by early/mid 2021 except for small hospital EDs which saw a much quicker rebound by late 2020. This national data gives health care providers/administrators information about what can happen during a modern day pandemic. If another pandemic occurs in the future mandating lockdowns, this data may be useful to guide resource and manpower allocations.

Fractures in Children Due to Firearm Activity

The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993–2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11–15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11–15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6–10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society.

Comprehensive Analysis of Pediatric Supracondylar Fractures in the Emergency Department; A Single Center Experience

Objective:

To describe the demographic characteristics and to assess possible risk factors related to the moment of presentation at Emergency Department (ED) for pediatric humeral supracondylar fractures.

Methods:

This was cross-sectional study being conducted during 5-year period from 2013 to 2017 at ED of a regional hospital in Spain. We have included all the pediatric patients (<14 years) with supracondylar fractures referring to our center during the study period. The demographic, clinical and radiological characteristics of the patients were recorded. The outcome and treatment strategies were also recorded. The risk factors of the pediatric supracondylar fracture was also assessed in our series.

Results:

We have included 52 pediatric patients with supracondylar fractures in this series. The mean age was 7.48 ± 2.97 years with a minimum age of 2 years and a maximum of 14 years. Among the patients there were 32 (61.54%) male and 20 (38.46%) female. Age less than 7 years found to be a protective factor against unstable fractures [OR 0.33 (0.10 - 1.02)]. Fractures presented during daytime hours showed a greater instability [OR 3.49 (1.07-11.39)]. However, the risk of presentation at nighttime was higher during the summer months (June to September).

Conclusion:

The older is the child, the greater is the risk of suffering an unstable fracture, which increases the need for surgery. This risk is greater during the daytime. Otherwise, during the summer months, there is a higher risk of patient presentation at nighttime.

Temporal characteristics of paediatric supracondylar humerus fractures

Objective

Supracondylar humeral fractures are the most common elbow injury occurring in the paediatric population, accounting for 55–80% of all elbow fractures and 3–18% of all paediatric fractures. They occur most commonly due to a fall from play equipment or furniture. This study aims to determine if any relationship exists between supracondylar humeral fractures and any temporal or injury characteristics. It was hypothesised that an increased incidence of supracondylar fractures would be observed in summer months and on weekends.

Methods

All patients <18 years of age with an isolated distal humerus supracondylar fracture between 2004 and 2014 were included in this study ( n = 569). Patient demographics and fracture characteristic data were collected. Hypothesis testing was performed to assess for any statistically significant relationship between fracture incidence and temporal or injury characteristics. Patients were then divided based on their management (conservative vs. operative) and hypothesis testing was performed to determine whether any difference existed between the management groups with regards to temporal and injury characteristics.

Results

No statistically significant association was noted between fracture incidence and gender, laterality, or day/month/season of injury. Time of injury and presentation to the Emergency Department demonstrated significant results, with highest incidence in the afternoon hours (12:00–17:59).

Conclusions

Unlike previous international studies, no significant difference was noted between day/month/season of injury and incidence of supracondylar fracture. This is thought to be likely due to the difference in climate between Australia and other countries.