» Is Increase in Fracture Surgery in Children Justified?
Is Increase in Fracture Surgery in Children Justified?

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Children are known for getting into scrapes and often enough, breaking bones. Statistics show that about 10 to 25 percent of all injuries among children are bone fractures (breaks). But, despite fractures being relatively common, not much research has been done about the best way to treat these fractures nor how frequently certain fractures occur.

The authors of this study wanted to look at how often children broke bones and how the breaks were treated. To do this, researchers evaluated the records of Finnish children who had been admitted to a hospital because of a fracture between 1997 and 2006. It was found that more children had fractures in the later part of the study period - 13.5 percent difference at the end of the study, compared with beginning. Although the rate of lower extremity fractures remained about the same throughout the nine years, there was a 23 percent increase in upper extremity fractures.

The children were divided into four groups:

  • non-ambulatory (younger than one year)
  • pre-school age (one to six years)
  • school age not licensed to drive (seven to 14 years)
  • school aged, licensed to drive a light motorcycle or scooter, but not a car (15 to 17)

The researchers were looking for the type of fracture (diagnosis), how it happened (mechanism), the type of surgery, and length of hospital stay. The results showed that there were 37,271 fractures that required admission to hospital. Among them 28,870 required surgery. The rate of surgery increased over time by 20 percent from the first year (1997) to the last (2006). The most common age group to have surgery was among those younger than 15 years (23 percent) compared with older adolescents (15 to 17 years), with only a 4.6 percent increase.

Surgery for forearm fractures showed a 62 percent increase; upper arm increased by 18 percent. Breaking down the groups for these surgeries, those children between one and seven years old had an increase of 29 percent for forearm surgery; 78 percent increase in the eight to 14 age group; and 90 percent in the 15 and older age group.

While not strictly surgery, some children have to go under general anesthetic to have their broken bones set or reduced. This treatment, called closed reduction, because it doesn't involve surgery, didn't increase over the study period. Usually, this is the usual method of treating forearm fractures. It has also been found to be quite effective in treating upper arm fractures, with lower complication rates than surgery.

Not forgetting lower-extremity fractures, the researchers found that the slight increase in that type of surgery is understandable. Better use of x-rays and other imaging equipment allows doctors to have a better look at what they are dealing with. However, it still has not yet been proven that the surgery is superior to reduction.

When looking at the frequency and types of surgeries, the researchers searched for ways to predict who would have to have surgery. They found that upper extremity fractures needed more surgical procedures than lower extremity and that surgery was more likely in adolescents aged 15 to 17 years.

The study also looked at re-interventions, situations that required a repeat treatment or surgery. Re-interventions increased by 46 percent overall, 28 percent if the reason was for misalignment of the bone. Hospital stays varied in length, dropping from 44 percent to 38 percent.

In conclusion, the study's authors concluded that more surgeries were being done to treat fractures among children, particularly over the past 10 years. However, there didn't seem to be any supporting evidence as to why the surgical procedures increased so much. The authors wrote, "On the basis of current knowledge, the increase surgery rate for upper-extremity fractures is difficult to support. In addition, we did not find that the rate of re-reductions of fractures had decreased, despite the increased rate of surgery."

Reference: Ilkka Helenius, MD, PhD, et al. Operative Treatment of Fractures in Children is Increasing. In Journal of Bone and Joint Surgery. No. 91. Pp. 2612 to 2616.