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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 26-28

Seasonality in pediatric and adolescent orthopedic fractures – An experience from central India


Department of Orthopedics, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India

Date of Submission28-Oct-2019
Date of Acceptance27-Jul-2020
Date of Web Publication16-Jun-2021

Correspondence Address:
Dr. Rajeev Shukla
Department of Orthopedics, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_42_19

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  Abstract 


Background: Incidence of childhood fractures varies from 1.2% to 5%. Very few studies have considered environmental variables which may influence incidence of fractures, that too in pediatric age group. According to literatures incidence of fracture is found to be higher in summers as compared to winters. Aims and Objectives: To study the seasonal variation of pediatric and adolescent orthopedic fractures at our institute in Central India. Materials and Methods: Data of orthopaedic trauma in patients of age 0-18 years were collected from the institutional database of a tertiary care hospital for the period 2007–2017. Basic demographic characteristics, time and date of injury, nature of injury and outcome data were recorded and tabulated according to age, sex, month/season, part of body injured, and then analyzed for the patterns of injury. Results: A total of 3260 pediatric orthopedic trauma cases were included in study. Most of the injuries were seen in 6–15 years' age group (64%), most common mode of injury was fall while playing. There was a male preponderance to fractures (73% males vs. 27% females). Trauma mostly occurred during summers (48%) followed by rainy season (30%) and least during winter season (22%). Injury to spine was seen in 31 (0.95%) patients, upper limb injuries were seen in 1799 (55.18%) patients, and lower limb injuries were seen in 1430 (43.86%) patients. Conclusion: This study concludes that there exists vast variation in the incidence of fractures in the pediatric and adolescent fractures with maximum fractures being reported in the summer season, then rainy season, and least in the winter season. Health-care professionals and parents should be educated about injury prevention strategies, and also, there should be commitment for more health-care personnel and resources at trauma centers during the summer season to deal with increased patient load efficiently.

Keywords: Adolescent fractures, pediatric fractures, seasonal variation in fractures, seasonal variation in orthopedic trauma


How to cite this article:
Jain RK, Shukla R, Dogne R, Champawat VS. Seasonality in pediatric and adolescent orthopedic fractures – An experience from central India. J Orthop Traumatol Rehabil 2021;13:26-8

How to cite this URL:
Jain RK, Shukla R, Dogne R, Champawat VS. Seasonality in pediatric and adolescent orthopedic fractures – An experience from central India. J Orthop Traumatol Rehabil [serial online] 2021 [cited 2021 Dec 9];13:26-8. Available from: https://www.jotr.in/text.asp?2021/13/1/26/318411




  Introduction Top


Childhood fractures are very common,[1],[2],[3] with an incidence varying from 1.2% to 5%, as reported by many studies.[4],[5],[6]

At present, very few studies have considered environmental variables along with the working schedule which may influence injury to bone or trauma.[7]

Like any other disease, trauma also follows its own natural history and epidemic pattern.[8] Population with certain age, and at particular time in a day, or week, the incidence of fracture is found to be increased. The incidence is found to be higher in summers in comparison to winters.[8] A statistically significant correlation was reported between the temperature and incidence of trauma.[9]

The purpose of this study was to document the seasonal variation of pediatric and adolescent orthopedic fractures in Central India, as it has not been reported earlier in any of the study.

This study examined the seasonal variation of several pediatric and adolescent orthopedic fractures based on the data collected from our institutional data base.


  Materials and Methods Top


The present study was conducted in the department of orthopedics in our institution after getting the approval from the Institutional Ethical Review Board. Data of pediatric and adolescent orthopaedic trauma were collected from the institutional database for the period 2007–2017. Patients of age 0–18 years presenting with injury to casualty department were included in the study after getting their and/or their legally acceptable representative's voluntary written informed consent for participation. Basic demographic characteristics, time and date of injury, nature and cause of injury, vital signs, and outcome data were recorded and tabulated according to age, sex, month/season, part of body injured, and then analyzed for the patterns of injury.


  Results and Discussion Top


In our institution, during the study period from 2007 to 2017, around 3260 pediatric orthopedic trauma cases were seen. Most of the injuries were seen in 6–15 years' age group (64%), of which 6–10 years' age group suffered the maximum injuries (34%) [Table 1] and [Figure 1].
Table 1: Distribution of patients according to age

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Figure 1: Pie diagram showing distribution of patients according to age

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Most common mode of injury was fall while playing. There was a male preponderance in our study (73% males vs. 27% females), with a male: female ratio of 2.7:1 [Table 2] and [Figure 2]. Ng'ambi and Borgstein[10] reported fall being the most common cause of trauma in 42.9% in their study participants. Cheng and Shen[11] also supported our findings showing a higher male preponderance in their study with a male:female ratio of 2.7:1.
Table 2: Distribution of patients according to sex

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Figure 2: Pie diagram showing the distribution of patients according to sex

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Trauma mostly occurred during summers (48%) followed by rainy season (30%) and least during winter season (22%) [Table 3]. A study done by Jespersen et al.[12] reported a lower incidence of injury in the winter (0.8%) in comparison to the autumn (1.3%) and spring (1.2%). Cheng and Shen[11] reported a higher incidence of fractures in children during the months of summer and autumn, both studies supporting our findings.
Table 3: Distribution of fractures according to season

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Injuries to spine were seen in 31 (0.95%) patients, upper limb injuries were seen in 1799 (55.18%) patients, and lower limb injuries were seen in 1430 (43.86%) patients. Our study had reported a higher incidence of upper limb injuries [Table 4], while the study done by Jespersen et al.[12] reported a higher incidence of lower limb injuries in their study.
Table 4: Distribution of fractures according to fractured extremity

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During the summers, majority of the trauma patients presented to the emergency room and orthopedic department ward with fracture of upper extremity, especially elbow which was commonly seen in 312 (19.93%) and the fracture supra-condylar humerus were most common around 243 (15.53%). The probable cause being vacations of school during the summers. Moreover, in rainy season, there was dominance of lower extremity fracture which were fracture of femur (i.e., 201; 20.55%) and fracture of tibia (i.e., 160; 16.35%), respectively. In winter, there was almost equal prevalence of fracture around elbow (160; 16.31%), radius/ulna (112; 15.62%), femur (131; 18.27%), and tibia (114; 15.89%) [Table 2]. Jespersen et al.[12] showed a 46% increase in injury incidence and a 32% increase in injury prevalence during summer relative to winter for lower and upper limb extremity injuries combined. Cheng and Shen[11]reported most common fracture as distal radius fractures seen in 19.87%, followed by supracondylar fracture of the humerus (16.64%) and forearm shaft fracture (13.36%).

There are various studies documenting seasonal variation in pediatric fractures, but very few explain the clinical significance.

After analyzing the seasonality in pediatric and adolescent orthopedic fractures, the orthopedic surgeons have an opportunity in injury control and prevention and also in managing resources in trauma center. Parents should be educated with specific strategies to minimize the injury contact, especially for children presenting to the emergency room with a history of trauma not leading to fractures as these may be prone in future for multiple episodes of trauma. Greater attentiveness on children should be given during the summers, especially during the vacations, as children are mostly playing outside, climbing trees, or doing some other climbing activities. Such attentiveness will decrease the incidence of such traumas. Furthermore, the children can be given instructions to help them avoid such injuries.

Providing nonslip footwear to the children during rainy seasons and keeping the floors dry at all times will help injuries from slip. Majority of the fall in winter was seen from bed. Making children <2 years to sleep on beds with low height with side rails, will help in avoiding major injuries due to fall from beds during winters. Parents should maintain physical contact with infant in bed while sleeping.


  Conclusion Top


The results of the present study conclude that there exists vast variation in the incidence of fractures in the pediatric and adolescent fractures with maximum fractures being reported in the summer season, then rainy season, and least in the winter season. Health-care professionals and parents should be educated about injury prevention strategies, and also, there should be commitment for more health-care personnel and resources at trauma centers during the summer season to deal with increased patient load efficiently.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983;202:1-09.  Back to cited text no. 1
    
2.
Jones IE, Williams SM, Dow N, Goulding A. How many children remain fracture-free during growth? a longitudinal study of children and adolescents participating in the dunedin multidisciplinary health and development study. Osteoporos Int 2002;13:990-5.  Back to cited text no. 2
    
3.
Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in britain: A study using the general practice research database. J Bone Miner Res 2004;19:1976-81.  Back to cited text no. 3
    
4.
Donaldson LJ, Reckless IP, Scholes S, Mindell JS, Shelton NJ. The epidemiology of fractures in England. J Epidemiol Community Health 2008;62:174-80.  Back to cited text no. 4
    
5.
Jones G. Growth, children, and fractures. Curr Osteoporos Rep 2004;2:75-8.  Back to cited text no. 5
    
6.
Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury 2007;38:913-22.  Back to cited text no. 6
    
7.
Livingston KS, Miller PE, Lierhaus A, Matheney TH, Mahan ST. Does weather matter? The effect of weather patterns and temporal factors on pediatric orthopedic trauma volume. Open Orthop J 2016;10:550-8.  Back to cited text no. 7
    
8.
Shukla R, Jain N, Agarwal U, Sheikh T, Jain R. Seasonal variation in orthopedic trauma patients-An experience from central India. J Clin Orthop Trauma 2018;9:S40-S43.  Back to cited text no. 8
    
9.
Rising WR, O'Daniel JA, Roberts CS. Correlating weather and trauma admissions at a level I trauma center. J Trauma 2006;60:1096-100.  Back to cited text no. 9
    
10.
Ng'ambi TM, Borgstein ES. Epidemiology of paediatric trauma admissions at Queen Elizabeth Central Hospital, Blantyre. Malawi Med J 2005;17:5-6.  Back to cited text no. 10
    
11.
Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: A study of 3,350 children. J Orthop Trauma 1993;7:15-22.  Back to cited text no. 11
    
12.
Jespersen E, Holst R, Franz C, Rexen CT, Wedderkopp N. Seasonal variation in musculoskeletal extremity injuries in school children aged 6-12 followed prospectively over 2.5 years: A cohort study. BMJ Open 2014;4:e004165.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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