EPIDEMIOLOGY OF CHILDHOOD FRACTURES IN THE CITY OF KARACHI
Abstract
Background: The epidemiology of paediatric fractures is crucial for developing preventive strategies, but when it comes to developing countries, the urban scenario has rarely been studied in the context of childhood trauma. This study aims to identify the epidemiology of paediatric injuries occurring in the largest and most populated city of Pakistan, Karachi, so that a comparison to data from the developed world can be made, and appropriate precautionary measures can be devised. Methods: The data from 1,514 paediatric orthopaedic patients treated at the Accident and Emergency department of Jinnah Postgraduate Medical Centre, during the time frame ranging from January 2012 to January 2013 was studied. Survey forms were filled out by the residents on call. Results: The patients’ ages ranged from 2 months to 17 years, with males outnumbering females. The mean age of presentation was 8.8±4.6years. The number of fractures was maximal among children aged 5–11 years, after which it decreased in adolescents. Fractures of the radius and ulna were most common (16.9%), followed by the distal radius (14.6%) and humerus (12.0%). Patients aged 0–2 years most commonly presented with a fracture of the femoral shaft. Falls on the same plane were responsible for the most fractures (44.2%), followed by falls from a height (21.5%) and road traffic accidents(26.7%).Incidence of fractures peaked in the summer months (p=0.007). Conclusion: Adequate precautionary measures and preventive programs need to be inculcated through legislation and a community based effort. In a developing nation however, unless the issues of ignorance, illiteracy and poverty are tackled by the authorities, they will continue to be a major hindrance.References
Sleet DA, Dahlberg LL, Basavaraju SV, Mercy JA, McGuire LC, Greenspan A; et al. Injury Prevention, Violence Prevention, and Trauma Care: Building the Scientific Base. MMWR Surveill Summ 2011;60(Suppl):78–85.
Murray CJL, editor. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 ; summary. Cambridge: Harvard School of Public Health 1996; p.43.
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause, 1990-2020: global burden of disease study. Lancet 1997;349(9064):1498–504.
Deen JL, Vos T, Huttly SR, Tulloch J. Injuries and noncommunicable diseases: emerging health problems of children in developing countries. Bull World Health Organ 1999;77(6):518–24.
World Health Organization. Child and adolescent injury prevention: a global call to action. Geneva: World Health Organization; 2005. p.16.
Fatmi Z, Kazi. A, Hadden. WC, Bhutta Z, Razzak. JA, Pappas G. Incidence, pattern and disability of unintentional injuries among children under 5 years of age: results of the National Health Survey of Pakistan. Paediatr Perinat Epidemiol 2009;23(3):229–38.
. Kobusingye O, Guwatudde, Lett R. Injury patterns in rural and urban Uganda. Inj Prev 2001;7(1):46–50.
MacInnes K, Stone DH: Stages of development and injury: an epidemiological survey of young children presenting to an emergency department. BMC Public Health 2008;8:120.
National Safety Council 1992 Accident Facts. Chicago, Illinois 1992.
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;202:1–109.
Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 1993;7(1):15–22.
Hedström EM, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents. Acta Orthop 2010;81(1):148–53.
Ma D, Morley R, Jones G. Risk-taking, coordination and upper limb fractures in children: a population based case-control study. Osteoporos Int 2004;15(8):633–8.
National Institute of Population Studies (NIPS) [Pakistan], and Macro International Inc. Pakistan Demographic and Health Survey 2006–07. Islamabad, Pakistan: National Institute of Population Studies and Macro International Inc 2008.
Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, et al. Femoral fractures in children younger than three years: the role of nonaccidental injury.J Pediatr Orthop 2008;28(3):297–302.
Kocher MS, Kasser JR. Orthopaedic aspects of child abuse. J Am Acad Orthop Surg 2000;8(1):10–20.
Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D status in abused and nonabused children younger than 2 years old with fractures. Pediatrics 2011;127(5):835–41.
Lasi S, Rafique G, Peermohamed H: Childhood injuries in Pakistan: results from two communities. J Health Popul Nutr 2010;28(4):392–8.
Reinberg O, Reinberg A, Téhard B, Mechkouri M. Accidents in children do not happen at random: Predictable time-of-day incidence of childhood trauma. Chronobio l Int 2002;19(3):615–31.
Christoffel KK. Toward reducing pediatric injuries from firearms: charting a legislative and regulatory course. Pediatrics 1991;88(2):294–305.
Nasrullah M, Razzak JA. Firearm Injuries Presenting to a Tertiary Care Hospital of Karachi, Pakistan. J Inj Violence Res 2009;1(1):27–31.
Nafees AA, Khan KS, Fatmi Z, Aslam M. Situation analysis of child labour in Karachi, Pakistan: a qualitative study. J Pak Med Assoc 2012;62(10):1075–82.
Saluja G, Brenner R, Morrongiello BA, Haynie D, Rivera M, Cheng TL. The role of supervision in child injury risk: definition, conceptual and measurement issues. Inj Control Saf Promot 2004;11(1):17–22.
Howard AW, MacArthur C, Willan A, Rothman L, Moses-McKeag A, MacPherson AK. The effect of safer play equipment on playground injury rates among school children. CMAJ 2005;172:1443–6.
Gallagher SS, Finison K, Guyer B, Goodenough S. The incidence of injuries among 87 000 Massachusetts children and adolescents: results of the 1980–81. Statewide Childhood Injury Prevention Programme Surveillance System. Am J Public Health 1984;74(12):1340–7.
Pardi LA, King BP, Salemi G, SalvatorAE. The effect of bicycle helmet legislation on pediatric injury. J Trauma Nurs 2007;14(2):84–7
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
