Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study.

INTRODUCTION: Recent studies investigating the frequency of paediatric fractures in Germany are not available. The primary aim of this study was to report frequencies of the most common paediatric upper extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time.

METHODS: This study used inpatient data from the German National Hospital Discharge Registry. Absolute frequencies and incidences of the following fracture localisations were analysed: clavicle, proximal humerus, humerus shaft, distal humerus, ulna shaft, radius shaft, forearm shaft, distal radius, and distal forearm. Four age groups were formed: 0-4, 5-9, 10-14, and 15-19 years. The boy-girl ratio (BGR) was calculated for all fracture localisations for both years, respectively. Incidence rate ratios (IRRs) were calculated to compare fracture incidences between 2002 and 2017.

RESULTS: The absolute number of the nine fracture localisations together decreased from 38,480 in 2002 to 35,128 in 2017. The overall BGR was 2.0 in both years. The BGR increased with increasing patient age. The incidence of clavicle fractures increased from 2002 to 2017 (IRR ≥ 1.72), while that of humerus fractures (proximal, shaft, and distal) remained the same or decreased (IRR ≤ 1.00) within all age groups. The incidence of isolated ulna or radius shaft fractures increased slightly or remained the same in the two lower age groups (IRR ≥ 1.00), while it decreased in the two higher age groups (IRR ≤ 0.80). Furthermore, complete forearm fractures were more frequent in the 0-4, 5-9, and 10-14 year age groups (IRR ≥ 1.44) in 2017 compared to 2002. The incidence of distal radius und forearm fractures changed only slightly.

CONCLUSIONS: The absolute number of paediatric upper extremity fractures decreased from 2002 to 2017, while the incidence of in-hospital treatment of clavicle and forearm fractures increased significantly, indicating a trend towards operative treatment.