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Adult vs Pediatric Cases: Upper Extremity Open Fractures

A study published on BioMedCentral shows that fractures in pediatrics tend to show epidemiological characteristics which are different from adults – the main goal was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients.

Adult and pediatric fractures’ epidemiology was studied in Edinburgh, Scotland, where it was found that the incidence of fractures in children was almost twice than in adults. Male and female adults were affected, but a strong male predominance was felt in the pediatric cases.  Adults tend to present multiple and open fractures and children often present mainly with upper limb fractures and have relatively few lower limb fractures.

Recent studies show that on upper extremity fractures in road traffic accidents (hospitalized adult and pediatric patients, the fracture rate in children is less than that in adults. On a total number of pedestrian accidents, around 22% of the children sustained fractures, while 40% of the adults sustained fractures in the same type of accident. Multiple UEFs were similar between the groups – 23% in the pediatric group and 22% in the adult group.Associated injuries to UEFs were found in about half of the pediatric group – 56% – but in most of our adult population group – 76%. It was felt that fractures which included the forearm, humerus, and clavicle were similar in both groups.

The data collected in the study reveals that soft tissue damage and compartment syndrome are relatively uncommon in open fractures. A study in Edinburgh, Scotland, made between 2007-2008 indicates that 59% of the fractures were in the upper limb and only 2,6% of 5271 fractures were open which showed that opens UEFs as a result of RTAs are common in patients admitted to the hospital, with up to 12% of the fractures. It was demonstrated that adults had a greater risk for open UEFs than children.

Open fractures, according to the mode of injury, were up to 14% in car occupants. For example, Richter et al. demonstrated that a total of 16% of all cases of front seat car occupants were open injuries while Court-Brown et al. found that only 22,3% of adult open fractures were caused by RTAs or falls from a height. When involved in vehicle accidents, about 22% of the children had fractures, while 40% of the adults sustained fractures in the same type of accident. Children are usually more likely to bounce when hit.

An open UEF according to the type of bone in the adult general population occurs in the phalanges followed by the forearm – data which was not studied in the pediatric population. The adult group had a similar distribution of fractures type but the pediatric group had more ulna fractures than clavicle fractures.

This study, however, had some limitations regarding its retrospective nature and the data concerning only hospitalized patients with no data related to close fractures, other body parts, open fractures classification, or other soft tissue complications.

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