The Journal of Bone and Joint Surgery (American). 2009;91:2612-2616.
doi:10.2106/JBJS.H.01519
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Operative Treatment of Fractures in Children Is Increasing

A Population-Based Study from Finland

Ilkka Helenius, MD, PhD1, Tommi S. Lamberg, MD, PhD2, Sakari Kääriäinen, MSc3, Antti Impinen, MSc3 and Mikko P. Pakarinen, MD, PhD4

1 Section of Pediatric Surgery, Turku Children's Hospital, Turku University Central Hospital, P.O. Box 499, FIN-20521, Turku, Finland. E-mail address: ilkka.helenius{at}helsinki.fi
2 Porvoo Hospital, Hospital District for Helsinki and Uusimaa, P.O. Box 500, FIN-06151, Porvoo, Finland
3 National Research and Development Center for Welfare and Health, FIN-00280, Helsinki, Finland
4 Section of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, FIN-00029 HUS, Helsinki, Finland

Investigation performed at Turku Children's Hospital, Turku; Hospital for Children and Adolescents, Helsinki; and the National Research and Development Center for Welfare and Health, Helsinki, Finland

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Baxter and in excess of $10,000 from the Finnish Foundation for Paediatric Research and Medtronic International. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Medtronic International). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Epidemiological data on the incidence of surgical treatment of pediatric fractures are sparse. Our aim was to determine the incidence of in-hospital-treated fractures and of the surgical treatment of these fractures in children and adolescents.

Methods: National Discharge Register data on pediatric fractures (in patients younger than the age of eighteen years) treated in the hospital in Finland between 1997 and 2006 were evaluated.

Results: During the ten-year follow-up period, the incidence (per 100,000 persons) of fractures leading to hospitalization increased by 13.5% (from 319 in 1997 to 362 in 2006; p < 0.001). This change resulted mainly from an increase in the incidence of hospital-treated upper-extremity fractures (23% increase; from 189 in 1997 to 232 in 2006). The incidence of primary fracture surgery increased by 20% (from 237 in 1997 to 284 in 2006; p < 0.001). The incidences of surgery for upper-extremity, lower-extremity, and axial fractures increased by 28%, 3.9%, and 10.7%, respectively. Within the upper-extremity-fracture group, the incremental increase was mainly due to an increase in forearm fracture surgery (62% increase; from fifty-five in 1997 to eighty-nine in 2006) (p < 0.001).

Conclusions: Operative treatment of children's fractures has increased markedly during the last ten years. Evidence-based medical and economic data supporting this change in practice are sparse.


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