Experimental Biology 2010: Epidemiology Of Pediatric Forearm Fractures In Washington DC, 2003-2006

Purpose of Study: Forearm fractures account for 25% of all fractures in children. These fractures result in substantial morbidity and estimated costs exceeding $2 billion dollars per year in the United States. Despite the success of public health efforts in the prevention of other injuries, the incidence of pediatric forearm fractures is increasing for unclear reasons. The epidemiology of these injuries, including mechanism of injury, has not been well described in the pediatric population. Our objective was to characterize the epidemiology of forearm fractures in children evaluated in an urban pediatric emergency department (ED).

Methods Used: This retrospective study included Washington DC children, ages 0-17, treated for an isolated forearm fracture in the Children's National Medical Center ED from 2003-2006. Patients with bone mineralization disorders and repeat ED visits for the same fracture event were excluded. Chart review was done to obtain demographic and clinical data. Descriptive epidemiologic and bivariate analyses were conducted.

Summary of Results: This preliminary analysis included 929 patients. The majority of patients were male (64%) and African-American (80%). The mean age (+ SD) was 8.4 years (+ 3.9). Weight-for-age percentile was greater than or equal to 95% in 24.1% of cases. Most forearm fractures occurred during the spring season. The most common mechanism of injury was fall-related (83%) whereas direct trauma caused 10% of fractures. Fall from monkey bars was the specific mechanism in 17% of all cases. Of the 593 cases in which a detailed mechanism was described, 539 fractures (91%) resulted from minor trauma. The mechanism of injury in 42% of minor trauma-related forearm fractures was a fall from standing height.

Conclusions: Falls from monkey bars and minor trauma are implicated in the majority of childhood forearm fractures. Prevention strategies should target playground safety. Further research is needed to evaluate factors, including obesity and bone health, which may contribute to forearm fracture risk associated with minor trauma.