Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. e543-e552 (doi:10.1542/10.1542/peds.2004-1064)
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ELECTRONIC ARTICLE

Childhood Femur Fractures, Associated Injuries, and Sociodemographic Risk Factors: A Population-Based Study

Arleta Rewers, MD, PhD, MSPH*, Holly Hedegaard, MD, MSPH{ddagger}, Dennis Lezotte, PhD§, Katy Meng, PhD{ddagger}, F. Keith Battan, MD*, Kathryn Emery, MD* and Richard F. Hamman, MD, DrPH§

* Departments of Pediatrics
§ Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, Colorado
{ddagger} Colorado Department of Public Health and Environment, Denver, Colorado

Objective. The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors.

Methods. The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively.

Results. During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92–2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft + distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In small-area analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics.

Conclusions. Femur fractures and associated injuries remain a major cause of morbidity in children. Predictors of femur fractures change with age; however, the risk is generally higher among children who live in the areas with lower socioeconomic indicators.

Key Words: children • fractures • injury patterns • injury prevention and control

Abbreviations: LOS, length of stay • ISS, Injury Severity Score • ED, emergency department • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • E-code, external-cause code • SES, socioeconomic status • IQR, interquartile range • CI, confidence interval • NAT, nonaccidental trauma • RR, risk ratio • MVC, motor vehicle crash

Accepted Jan 22, 2005.


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