Changing trends in the management of pediatric distal forearm fractures: a descriptive Danish 20-year nationwide registry study of 175,083 cases
DOI:
https://doi.org/10.2340/17453674.2025.45057Keywords:
Forearm, Fractures, Paediatric orthopaedicsAbstract
Background and purpose: Management of pediatric distal forearm fractures ranges from no or simple immobilization to surgical fixation. Treatment decisions depend on age and fracture severity, but practices vary widely across countries. As surgical intervention has increased internationally, we aimed to investigate national trends in incidence and treatment of pediatric distal forearm fractures in Denmark from 1999–2018
Methods: We conducted a population-based register study of children aged 0–15 with distal forearm fractures (S525 + S526) registered in the Danish National Patient Registry from 1999–2018. Treatments within 1 week of injury were grouped into: non-surgical (no immobilization, soft bandage or cast immobilization), closed reduction and immobilization, and surgical fixation. Procedure codes included closed reduction, open reduction, K-wires, or other fixations such as external fixation, nail, plate, or screws.
Results: There were 175,083 fractures over the 20 years, yielding a mean incidence of 829/100,000/year in children aged 0–15 years. The highest incidences were 1,494/100,000 among 11-year-old girls and 1,720/100,000 among 13-year-old boys. The primary treatment in all age groups was non-surgical treatment, though decreasing from 92% in 1999 to 89% in 2018. The proportion of closed reduction declined from 7% to 2%, while K-wire fixation increased from 1% to 8%. When stratified by age groups, the same trend was seen in all but the 0–3-year-olds.
Conclusion: The overall incidence remained stable during the study period. Non-surgical treatment remained predominant, whereas closed reductions decreased in favor of more K-wire fixations.
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References
Hedström E M, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents: increased incidence over the past decade: A population-based study from northern Sweden. Acta Orthop. 2010; 81(1): 148-53. doi:10.3109/17453671003628780 DOI: https://doi.org/10.3109/17453671003628780
Bergkvist A, Lundqvist E, Pantzar-Castilla E. Distal radius fractures in children aged 5–12 years: a Swedish nationwide register-based study of 25 777 patients. BMC Musculoskelet Disord 2023; 24(1): 560. doi:10.1186/s12891-023-06680-8 DOI: https://doi.org/10.1186/s12891-023-06680-8
Perry D C, Achten J, Knight R, Appelbe D, Dutton S J, Dritsaki M, et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet (London, England) 2022; 400(10345): 39-47. doi:10.1016/S0140-6736(22)01015-7 DOI: https://doi.org/10.1016/S0140-6736(22)01015-7
Labianca L, Calderaro C, Maffulli N. Pediatric wrist fractures: variations in management across countries. An evidence-based summary of evidence. Br Med Bull.Oxford Academic 2024; 152(1): 28-34. doi:10.1093/bmb/ldae014 DOI: https://doi.org/10.1093/bmb/ldae014
Korup L R, Larsen P, Nanthan K R, Arildsen M, Warming N, Sørensen S, et al. Children’s distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone Jt Open 2022; 3(6): 448-54. doi:10.1302/2633-1462.36.BJO-2022-0040.R1 DOI: https://doi.org/10.1302/2633-1462.36.BJO-2022-0040.R1
Mamoowala N, Johnson NA, Dias J J. Trends in paediatric distal radius fractures: an eight-year review from a large UK trauma unit. Ann R Coll Surg Engl 2019; 101(4): 297-303. doi:10.1308/rcsann.2019.0023 DOI: https://doi.org/10.1308/rcsann.2019.0023
Südow H, Navarro C M. The incidence of distal radius fractures in a Swedish pediatric population - an observational cohort study of 90 970 individual fractures. BMC Musculoskelet Disord 2021; 22(1): 564. doi:10.1186/s12891-021-04410-6 DOI: https://doi.org/10.1186/s12891-021-04410-6
Helenius I, Lamberg TS, Kääriäinen S, Impinen A, Pakarinen M P. Operative treatment of fractures in children is increasing: A population-based study from Finland. J Bone Joint Surg 2009;91(11):2612-2616. doi:10.2106/JBJS.H.01519 DOI: https://doi.org/10.2106/JBJS.H.01519
Patel D, Talbot C, Luo W, Mulvaney S, Byrne E. The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: a 5 year study. Injury 2021; 52(6): 1321-30. doi:10.1016/j.injury.2020.12.033 DOI: https://doi.org/10.1016/j.injury.2020.12.033
Delgove A, Harper L, Berciaud S, Lalioui A, Angelliaume A, Lefevre Y. Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department. Orthop Traumatol Surg Res 2019; 105(3): 513-5. doi:10.1016/j.otsr.2018.10.027 DOI: https://doi.org/10.1016/j.otsr.2018.10.027
Klingenberg L, Bødtker S, Balslev-Clausen A. Håndledsbrud hos børn. Ugeskr læger. 2023; 185(4): V02220104. [in Danish]
Västra Götalandsregionen. Distala Metafysära Radius- Och Ulnafrakturer Hos Barn - Handläggning.; 2023. [in Swedish]
Behandlingsrådet. Analyserapport Vedrørende Behandling Af Underarmsfrakturer Hos Børn 2025. [in Danish]
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Peteresen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med 2015; 12(10): e1001885. doi:10.1371/journal.pmed.1001885 DOI: https://doi.org/10.1371/journal.pmed.1001885
Statistics Denmark. Population figures. 2024. Accessed September 20, 2024. https://www.dst.dk/en/Statistik/emner/borgere/befolkning/befolkningstal
Retsinformation. Bekendtgørelse af lov om Det Centrale Personregister. 2020. Accessed September 4, 2023. https://www.retsinformation.dk/eli/lta/2020/1297 [in Danish]
Hansen B H, Toft L V. Afstand Til Nærmeste Sygehus: Fugleflugt Eller Vejafstand.; 2016. [in Danish]
Schmidt M, Schmidt S A J, Sandegaard J L, Ehrenstein V, Pedersen L, Sørensen H T. The Danish National patient registry: a review of content, data quality, and research potential. Clin Epidemiol 2015;7: 449-90. doi:10.2147/CLEP.S91125 DOI: https://doi.org/10.2147/CLEP.S91125
Hjelholt T J, Edwards N M, Vesterager J D, Kristensen P K, Pedersen A B. The positive predictive value of hip fracture diagnoses and surgical procedure codes in the Danish multidisciplinary hip fracture registry and the Danish national patient registry. Clin Epidemiol 2020; 12: 123-31. doi:10.2147/CLEP.S238722 DOI: https://doi.org/10.2147/CLEP.S238722
Karimi D, Houkjær L, Gundtoft P, Brorson S, Viberg B. Positive predictive value of humeral fractures in the Danish National Patient Registry. Dan Med J 2023; 70(4): A10220612.
Gundtoft P H, Danielsson F B, Houlind M, Mortensen S O, Corap Y, Bonde N, et al. The positive predictive value of ankle fracture diagnosis in the Danish National Patient Registry. Dan Med J 2022;69(12): A01220032.
Körner D, Gonser C E, Bahrs C, Hemmann P. Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study. Arch Orthop Trauma Surg 2020; 140(7): 887-94. doi:10.1007/s00402-019-03321-5 DOI: https://doi.org/10.1007/s00402-019-03321-5
De Putter C E, Van Beeck E F, Looman C W N, Toet H, Hovius S E R, Selles R W. Trends in wrist fractures in children and adolescents, 1997–2009. J Hand Surg Am 2011; 36(11): 1810-5.e2. doi:10.1016/j.jhsa.2011.08.006 DOI: https://doi.org/10.1016/j.jhsa.2011.08.006
Monget F, Sapienza M, McCracken K L, Nectoux E, Fron D, Andreacchio A, et al. Clinical characteristics and distribution of pediatric fractures at a tertiary hospital in northern France: a 20-year-distance comparative analysis (1999–2019). Medicina 2022; 58(5): 610. doi:10.3390/medicina58050610 DOI: https://doi.org/10.3390/medicina58050610
Hansen RT, Borghegn N W, Gundtoft P H, Nielsen K A, Balslev-Clausen A, Viberg B. Change in treatment preferences in pediatric diaphyseal forearm fractures: a Danish nationwide register study of 36,244 fractures between 1997 and 2016. Acta Orthop 2023; 94: 32-7. doi:10.2340/17453674.2023.7132 DOI: https://doi.org/10.2340/17453674.2023.7132
Franssen B B G M, Schuurman A H, Van der Molen A M, Kon M. One century of Kirschner wires and Kirschner wire insertion techniques: a historical review. Acta Orthop Belg 2010; 76(1): 1-6. PMID: 20306956
Qiu X, Deng H, Zhao Z, Zeng S, Zeng Y, Wang X, et al. Upper limb pediatric fractures in 22 tertiary children’s hospitals, China: a multicenter epidemiological investigation and economic factor analysis of 32,832 hospitalized children. J Orthop Surg Res 2022; 17(1): 1-16. doi:10.1186/s13018-022-03159-5 DOI: https://doi.org/10.1186/s13018-022-03159-5
Ellsworth B K, Bram J T, Haeberle H S, DeFrancesco C J, Scher D M. Back to basics: pediatric casting techniques, pearls, and pitfalls. Iowa Orthop J 2023; 43(2): 79-89. PMID: 38213863
Seeley M A, Fabricant P D, Lawrence J T R. Teaching the basics: development and validation of a distal radius reduction and casting model. Clin Orthop Relat Res 2017; 475(9) :2298-305. doi:10.1007/s11999-017-5336-3 DOI: https://doi.org/10.1007/s11999-017-5336-3
Abildgaard K R, Buxbom P, Rahbek O, Gottliebsen M, Gundtoft P H, Viberg B, et al. Is casting of displaced paediatric distal forearm fractures non-inferior to reduction under general anaesthesia? Study protocol for a pragmatic, randomized, controlled non-inferiority multicentre trial (the casting trial). Trials 2024; 25(1): 1-11. doi:10.1186/s13063-024-08253-z DOI: https://doi.org/10.1186/s13063-024-08253-z
Laaksonen T, Stenroos A, Puhakka J, Kosola J, Kautiainen H, Rämö L, et al. Casting in finger trap traction without reduction versus closed reduction and percutaneous pin fixation of dorsally displaced, over-riding distal metaphyseal radius fractures in children under 11 years old: a study protocol of a randomised controlled tria. BMJ Open 2021; 11(5): e045689. doi:10.1136/bmjopen-2020-045689 DOI: https://doi.org/10.1136/bmjopen-2020-045689
Balmert Bonner L, Janicki J, Georgiadis A, Truong W, Harris Beauvais D, Belthur M, et al. Distal Radius Interventions for Fracture Treatment (DRIFT) trial: study protocol for a multicentre randomised clinical trial of completely translated distal radius fractures at paediatric hospitals in North America. BMJ Open. 2025; 15(10): e088273. doi:10.1136/bmjopen-2024-088273 DOI: https://doi.org/10.1136/bmjopen-2024-088273
Perry D C, Achten J, Mason J, Kounail D, Nicolaou N, Metcalfe D, et al. The protocol for a multicentre prospective randomized noninferiority trial of surgical reduction versus non-surgical casting for displaced distal radius fractures in children Children’s Radius Acute Fracture Fixation Trial (CRAFFT) protocol. Bone Jt Open 2025; 6(5): 560-8. doi:10.1302/2633-1462.65.BJO-2024-0260 DOI: https://doi.org/10.1302/2633-1462.65.BJO-2024-0260
Gompels B, Rusby T, Limb R, Ralte P. Diagnostic accuracy and confidence in management of forearm and hand fractures among foundation doctors in the accident and emergency department: survey study. JMIR Form Res 2023; 7(1): e45820. doi:10.2196/45820 DOI: https://doi.org/10.2196/45820
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