Abstract
BACKGROUND: There are reports of increasing incidence of forearm shaft fractures in children. Their treatment has been preferably nonoperative but surgical fixation has gained popularity due to elastic stable intramedullary nailing. We aimed to study whether the incidence of pediatric both-bone forearm shaft fractures and their operative care have changed since year 2000. Trampoline injuries, in particular, and their treatment, re-displacement and short-term outcomes were the secondary outcomes of the study. METHODS: A population-based study in the geographic catchment area of Oulu University Hospital district in 20-years of time period (2000 - 2019) was performed. Altogether 481 diaphyseal both-bone forearm fractures in children (< 16 years) were included. Age- and sex-related incidence rates were determined, by using the official numbers of the population-in-risk by Statistics Finland. Trampoline jumping and other types of injury were reviewed, as well as particulars of treatment and outcomes. RESULTS: The incidence of diaphyseal both-bone forearm fractures increased from 9.4/100 000 in 2000-2001 to 41.7/100 000 in 2018-2019 (P < 0.001). Surgical treatment increased respectively (from 8.8/100 000 in 2000-2001 to 35.3/100 000 in 2018-2019, P < 0.0001). Trampoline injuries explained one in three (29%) of all fractures; they increased from 0% in 2000-2001 to 36.6% in 2018-2019 (P < 0.001). During the last four years of the study (2016-2019), most trampoline-related injuries occurred among girls (61.2%), compared to boys (38.8%) (P = 0.031). Trampoline-related injuries comprised 46.9% of all fractures in girls, compared to 26.0% among boys (Diff. 20.8%, 4.7% to 36.1%, P = 0.009). The mean age of the patients elevated from 6.4 years (2000-2001) to 8.6 years (2018-2019) (P = 0.015). Boys predominated (69.6%) in 2000-2009 but during the last ten years, there was no statistical difference in distribution between the genders (males 54.6%, P = 0.11). CONCLUSIONS: During the twenty-year's of study period, the incidence of pediatric diaphyseal forearm fractures increased fivefold. Trampolining was the most usual single reason for the fractures. More attention should be focused to increase the safety of trampoline jumping, in particular among the girls.