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Raspopovic KM, Bankovic D, Petrovic A, Opancina V, Nikolic S, Vojinovic RH. Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:129. [PMID: 38256390 PMCID: PMC10820898 DOI: 10.3390/medicina60010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.
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Affiliation(s)
- Katarina M. Raspopovic
- Institute for Children’s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro;
| | - Dragic Bankovic
- Faculty of Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Aleksandra Petrovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Simon Nikolic
- Faculty of Medicine, University of Kosovska Mitrovica, 11000 Belgrade, Serbia;
| | - Radisa H. Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
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Franceschi R, Radetti G, Soffiati M, Maines E. Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition? Calcif Tissue Int 2022; 111:107-115. [PMID: 35316361 DOI: 10.1007/s00223-022-00971-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/10/2022] [Indexed: 01/06/2023]
Abstract
Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Giorgio Radetti
- Division of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
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Ambrosio MR, Aliberti L, Gagliardi I, Franceschetti P, Zatelli MC. Bone health in adolescence. Minerva Obstet Gynecol 2021; 73:662-677. [PMID: 34905874 DOI: 10.23736/s2724-606x.20.04713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.
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Affiliation(s)
- Maria R Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Ludovica Aliberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Operative Unit of Endocrinology and Metabolic Diseases, Department of Oncology and Specialty Medicine, Ferrara University Hospital, Ferrara, Italy
| | - Maria C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Obese Children Have Different Forearm Fracture Characteristics Compared With Normal-weight Children. J Pediatr Orthop 2020; 40:e127-e130. [PMID: 31095010 DOI: 10.1097/bpo.0000000000001402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current estimates suggest that one third of children and adolescents are overweight and 1 in 5 are obese. Obese children are at increased risk of sustaining more complex fractures, failing nonoperative treatment, and experiencing more complications during treatment. The purpose of this study was to compare forearm fracture characteristics, treatment, and complications in grouped overweight and obese [OW+OB; body mass index-for-age percentile (BMI%) ≥85] pediatric patients compared with normal-weight (NW; BMI%≤84) patients. METHODS This was a retrospective comparative study of patients aged 2 to 17 years old who presented with a forearm fracture resulting from low-energy trauma between January 2010 and September 2017. Patients with incomplete height and weight data; an underlying condition that predisposes to fractures or altered fracture healing; and torus, greenstick, pathologic, and high-energy fractures were excluded. Demographics, fracture characteristics, treatment, and complications were recorded. Descriptive and inferential analyses were conducted. RESULTS A total of 565 patients (403 NW, 162 OW+OB) met the inclusion criteria. NW children sustained open fractures nearly twice as frequently as the OW+OB children but this was not statistically significant (9.7% vs. 4.9%; P=0.065). Subanalysis showed that NW children were 4.1 times more likely to sustain an open fracture compared with obese (BMI%≥95) children (9.7% vs. 2.4%; P=0.029). A significant relationship was found between BMI% and location of the fracture, the bones involved, and fracture type. The OW+OB children sustained more distal forearm fractures than midshaft and proximal forearm fractures. Isolated radial shaft fractures were more common in the OW+OB group, whereas isolated ulnar shaft fractures were more common in the NW group. There was no difference in associated neurovascular injury, initial nonoperative versus operative management, failure of nonoperative treatment, and treatment complications. CONCLUSIONS OW+OB children have different forearm fracture characteristics compared with their NW peers. The thick soft tissue envelope in obese children may be protective against an open forearm fracture. In contrast to previous studies, obesity was not associated with failure of nonoperative treatment or a higher rate of complications. LEVEL OF EVIDENCE Level III-prognostic.
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McCann MR, Ratneswaran A. The role of PPARγ in childhood obesity-induced fractures. GENES AND NUTRITION 2019; 14:31. [PMID: 31798753 PMCID: PMC6880598 DOI: 10.1186/s12263-019-0653-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/01/2019] [Indexed: 02/08/2023]
Abstract
Globally, obesity is on the rise with ~ 30% of the world’s population now obese, and childhood obesity is following similar trends. Childhood obesity has been associated with numerous chronic conditions, including musculoskeletal disorders. This review highlights the effects of childhood adiposity on bone density by way of analyzing clinical studies and further describing two severe skeletal conditions, slipped capital femoral epiphysis and Blount’s disease. The latter half of this review discusses bone remodeling and cell types that mediate bone growth and strength, including key growth factors and transcription factors that help orchestrate this complex pathology. In particular, the transcriptional factor peroxisome proliferator-activated receptor gamma (PPARγ) is examined as it is a master regulator of adipocyte differentiation in mesenchymal stem cells (MSCs) that can also influence osteoblast populations. Obese individuals are known to have higher levels of PPARγ expression which contributes to their increased adipocyte numbers and decreased bone density. Modulating PPAR*gamma* signaling can have significant effects on adipogenesis, thereby directing MSCs down the osteoblastogenesis pathway and in turn increasing bone mineral density. Lastly, we explore the potential of PPARγ as a druggable target to decrease adiposity, increase bone density, and be a treatment for children with obesity-induced bone fractures.
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Affiliation(s)
- Matthew R McCann
- 1Sydney Medical School, University of Sydney, Sydney, NSW 2006 Australia.,2Western Bone & Joint Institute, University of Western Ontario, London, ON N6A 2J9 Canada
| | - Anusha Ratneswaran
- 2Western Bone & Joint Institute, University of Western Ontario, London, ON N6A 2J9 Canada.,3Department of Physiology and Pharmacology, University of Western Ontario, London, ON N6A 2J9 Canada.,4Department of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8 Canada
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Abstract
Obese children with high-energy injuries present with more severe injuries, more extremity injuries, and higher Injury Severity Scores. They are at increased risk for complications, prolonged ventilation, and ICU stay and have increased mortality. Obesity is associated with altered bone mass accrual and higher fracture rates. Obese patients have a higher risk of loss of reduction of forearm fractures, more severe supracondylar fractures, and a higher likelihood of lateral condyle fractures. Obese patients are more likely to have complications with femur fractures and have higher rates of foot and ankle fracture.
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Audigé L, Slongo T, Lutz N, Blumenthal A, Joeris A. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop 2017; 88:133-139. [PMID: 27882814 PMCID: PMC5385106 DOI: 10.1080/17453674.2016.1258534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) describes the localization and morphology of fractures, and considers severity in 2 categories: (1) simple, and (2) multifragmentary. We evaluated simple and multifragmentary fractures in a large consecutive cohort of children diagnosed with long bone fractures in Switzerland. Patients and methods - Children and adolescents treated for fractures between 2009 and 2011 at 2 tertiary pediatric surgery hospitals were retrospectively included. Fractures were classified according to the AO PCCF. Severity classes were described according to fracture location, patient age and sex, BMI, and cause of trauma. Results - Of all trauma events, 3% (84 of 2,730) were diagnosed with a multifragmentary fracture. This proportion was age-related: 2% of multifragmentary fractures occurred in school-children and 7% occurred in adolescents. In patients diagnosed with a single fracture only, the highest percentage of multifragmentation occurred in the femur (12%, 15 of 123). In fractured paired radius/ulna bones, multifragmentation occurred in 2% (11 of 687); in fractured paired tibia/fibula bones, it occurred in 21% (24 of 115), particularly in schoolchildren (5 of 18) and adolescents (16 of 40). In a multivariable regression model, age, cause of injury, and bone were found to be relevant prognostic factors of multifragmentation (odds ratio (OR) > 2). Interpretation - Overall, multifragmentation in long bone fractures in children was rare and was mostly observed in adolescents. The femur was mostly affected in single fractures and the lower leg was mostly affected in paired-bone fractures. The clinical relevance of multifragmentation regarding growth and long-term functional recovery remains to be determined.
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Affiliation(s)
- Laurent Audigé
- AO Clinical Investigation and Documentation, Dübendorf;,Schulthess Clinic, Research and Development Upper Extremities, Zürich
| | - Theddy Slongo
- Department of Pediatric Surgery, Traumatology and Orthopedics, University Hospital (Inselspital), Bern
| | - Nicolas Lutz
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf;,Correspondence:
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Kim SJ, Ahn J, Kim HK, Kim JH. Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Paediatr 2016; 105:1152-7. [PMID: 27634684 DOI: 10.1111/apa.13343] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/21/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED Two of the most prevalent problems children facing worldwide are injuries and obesity. We conducted a systematic review of published studies that evaluated the effects of obesity on children with traumatic injuries. Six studies published between 2006 and 2014 were identified, comprising a total of 4594 children: 867 were obese and 3727 were not. Obese children were 25% more likely to have extremity fractures than nonobese children (p = 0.003), and their mortality rate was significantly higher at 4.7% versus 2.8% (p = 0.026). CONCLUSION Our review showed that obese children were more likely to have extremity fractures and die of traumatic injuries than nonobese children.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Joonghyun Ahn
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Hyung Kook Kim
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Jong Hun Kim
- Division of Infectious Diseases; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
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Moon RJ, Lim A, Farmer M, Segaran A, Clarke NMP, Dennison EM, Harvey NC, Cooper C, Davies JH. Differences in childhood adiposity influence upper limb fracture site. Bone 2015; 79:88-93. [PMID: 26027507 PMCID: PMC4521307 DOI: 10.1016/j.bone.2015.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 05/21/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children. METHODS Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data. RESULTS 401 children (67.1% male, median age 11.71 years, range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p<0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls. CONCLUSION Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures.
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Affiliation(s)
- Rebecca J Moon
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Adelynn Lim
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Megan Farmer
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Avinash Segaran
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Nicholas M P Clarke
- Paediatric Orthopaedics, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
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