Epidemiology of paediatric and adolescent fractures admitted to a South African provincial hospital

Abstract

BACKGROUND : There are limited studies available that examine the epidemiology of children and adolescents admitted with orthopaedic injuries in developing countries. Several unique factors in South Africa, such as a large socio-economic divide and a public health sector with limited resources, are suggested to influence injury patterns and fracture management. The data emanating from this study may play a role in identifying potential preventative measures. The aims of the study were to determine the age, sex, duration of admission, aetiology and management regimen of paediatric and adolescent patients admitted with fractures in a South African provincial hospital. PATIENTS AND METHODS : We did a cross-sectional review of medical records for the period 1 January 2016 to 31 December 2017 at a South African provincial hospital. Convenience sampling was done, and demographic and clinical data was collected from patient records. All patients younger than 18 years at the time of injury who were admitted with fractures of the limbs, pelvis or spine were included. Patients with incomplete clinical records were excluded. RESULTS : A total of 731 patients were admitted during this period. After excluding patients with incomplete records, 526 (72%) were included in the study. From these records we found a higher percentage of males admitted (73%) and the average age was 7.72 years. The average duration of admission was 8.59 days. A fall on ground level was the most common mechanism of injury (70.0%), followed by pedestrian vehicle accidents (12.2%). The most frequently fractured regions were the forearm (36.4%), humerus (26.5%) and femur (18.9%). Multiple fractures were sustained by 2.4% and additional non-skeletal injuries were sustained by 2.9%. There was one fatality: a patient who presented with gunshot trauma. CONCLUSION : Despite fall-related injuries being the most common cause for admission, pedestrian vehicle accident prevention can have the greatest effect on admissions. They require significantly longer hospitalisation and present more frequently with additional injuries. By implementing safety strategies and improving road infrastructure, we can theoretically decrease the number of serious paediatric admissions. LEVEL OF EVIDENCE : Level 4.