Fractures of the femoral shaft in children - Incidence, mechanisms, and sociodemographic risk factors

Background: Fractures of the femoral shaft in children are caused by major musculoskeletal trauma and result in high direct and indirect medical costs . To date, the American literature has focused on treatment options and out comes, but the epidemiology of these injuries has been generalized from Sca ndinavian studies reported in the 1970s and early 1980s. The goals of the c urrent study were (1) to determine the age, gender, and race-specific rates and mechanisms of fractures of the femoral shaft in children in a large Un ited-States-based population and (2) to identify associations between the r ates of these fractures and multiple sociodemographic indicators, Such info rmation is vital for preventive efforts. Methods: The Hospital Discharge Database of the Maryland Health Services Co st Review Commission for the years 1990 through 1996 was used to obtain dem ographic data on 1485 cases of acute fracture of the femoral shaft in patie nts who were less than eighteen years old, and data from the United States Bureau of the Census for the state of Maryland for the year 1990 were used to obtain denominator data. Reliable external-cause data were available fro m the 1995 and 1996 databases for 472 patients. Small-area analysis,vas per formed at the:zip-code level to determine associations between numerous soc iodemographic indicators and the rate of femoral shaft fracture, Results: The annual rate of femoral shaft fracture in children was 19.15 pe r 100,000, With regard to age, there was a bimodal distribution, with peaks at two and seventeen years, Boys had higher rates of fracture than: did gi rls at all ages, and blacks had higher rates than did whites, The primary m echanisms of fracture were age-dependent and included falls, for children l ess than six years old; motor vehicle-pedestrian accidents, for those six t o nine years old; and motor-vehicle accidents, for teenagers. Firearm-relat ed injuries accounted for 15 percent of the fractures,among black adolescen ts. Adverse socioeconomic conditions were significantly associated with hig her rates of fracture, Conclusions: The rates and mechanisms of femoral shaft fractures in childre n depend on age, gender, and race. For children living in the United States today, the epidemiology of these fractures is different than that describe d in earlier, Scandinavian reports.