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The Epidemiology of Infant Shaft Fractures of Femur or Humerus by Incidence, Birth, Accidents, and Other Causes
Johan von Heideken
Karolinska Institutet Department of Women's and Children's Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4708-9914
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Knowledge of femur and humerus shaft fractures during infancy is scarce. The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and those diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.
Methods: Children born in 1997–2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma, abuse, or bone fragility disorders. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population.
Results: The incidence for birth-related femur shaft fractures was 0.024‰ (n=45) and that for birth-related humerus shaft fractures was 0.101‰ (n=188). The incidence was 0.154‰ for later femur shaft fractures (n=287) and 0.073‰ for later humerus shaft fractures (n=142). Birth-related femur shaft fracture was associated with preterm, multiple birth, breech, cesarean, and small-for-gestational age, while humerus shaft fracture was associated with preterm, multiple birth, birth weight > 4,000 g, and shoulder dystocia. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with both fracture types, especially among those aged < 6 months, where approximately 20% and 14% of cases, respectively, were associated with abuse. Fall accidents were reported in 73% and 56% among those with later femur and humerus shaft fractures, respectively.
Conclusion: This study provides data on epidemiology, birth, parental characteristics, and reported accidents in relation to femur and humerus shaft fractures during infancy. Few children had a bone fragility diagnosis. Fall accidents were the main contributor to femur or humerus shaft fracture during infancy; however, the proportion of fractures attributed to maltreatment was high in children under 6 months.
Keywords
Femoral fracture, humeral fracture, diaphyses, infant, birth injuries, accidents, physical abuse
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On 11 Dec, 2020
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On 11 Dec, 2020
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Received 30 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 10 Oct, 2020
Reviewer #1 agreed
On 09 Oct, 2020
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The Epidemiology of Infant Shaft Fractures of Femur or Humerus by Incidence, Birth, Accidents, and Other Causes
Johan von Heideken
Karolinska Institutet Department of Women's and Children's Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4708-9914
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 25 Sep, 2020
Published
On 11 Dec, 2020
Published
On 11 Dec, 2020
No community comments so far
Editorial decision: Minor revision
On 01 Nov, 2020
Review #2 received
Received 30 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 10 Oct, 2020
Reviewer #1 agreed
On 09 Oct, 2020
Reviewers invited
Invitations sent on 06 Oct, 2020
Editor assigned
On 15 Sep, 2020
Submission checks complete
On 14 Sep, 2020
Editor invited
On 14 Sep, 2020
First submitted
On 12 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Knowledge of femur and humerus shaft fractures during infancy is scarce. The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and those diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.
Methods: Children born in 1997–2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma, abuse, or bone fragility disorders. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population.
Results: The incidence for birth-related femur shaft fractures was 0.024‰ (n=45) and that for birth-related humerus shaft fractures was 0.101‰ (n=188). The incidence was 0.154‰ for later femur shaft fractures (n=287) and 0.073‰ for later humerus shaft fractures (n=142). Birth-related femur shaft fracture was associated with preterm, multiple birth, breech, cesarean, and small-for-gestational age, while humerus shaft fracture was associated with preterm, multiple birth, birth weight > 4,000 g, and shoulder dystocia. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with both fracture types, especially among those aged < 6 months, where approximately 20% and 14% of cases, respectively, were associated with abuse. Fall accidents were reported in 73% and 56% among those with later femur and humerus shaft fractures, respectively.
Conclusion: This study provides data on epidemiology, birth, parental characteristics, and reported accidents in relation to femur and humerus shaft fractures during infancy. Few children had a bone fragility diagnosis. Fall accidents were the main contributor to femur or humerus shaft fracture during infancy; however, the proportion of fractures attributed to maltreatment was high in children under 6 months.
Figure 1
Figure 2