Forearm fractures in children

Prijelomi podlaktice (radiusa i/ili ulne) najčešći su prijelomi dječje dobi. Trećina njih čine prijelomi radiusa u distalnom dijelu. Pad na ispruženu ruku glavni je mehanizam ozljeđivanja. Dijagnoza se zasniva na anamnezi, fizikalnom statusu i rentgenskoj snimci. Postupak liječenja većinom je repozicija ulomaka i imobilizacija ruke. Velika pojavnost, i mogući loši ishodi liječenja opravdavaju propitivanje preventivnih mjera u nastanku ovih ozljeda u djece. Za uspješnu prevenciju, potrebito je znati mjesta i načine nastanka prijeloma. Cilj ovog rada je istražiti mjesta i načine nastanka prijeloma kostiju podlaktice u skupini zagrebačke djece. U retrospektivnu analizu uključeno je 395 djece, s prijelomom kostiju podlaktice, liječene (bolnički i ambulantno) u KBC-u Zagreb u periodu od 1. siječnja 2014. godine do 19. listopada 2017. godine. U ispitanoj skupini je 265 dječaka (67,1%) i 130 djevojčica (32,9%). Srednja životna dob iznosi 9,1 godina. Djevojčice su u prosjeku mlađe od dječaka 16 mjeseci. Najviše je djece u dobnoj skupini od 5.–9. godina, njih 175 (44,3%). Izolirani prijelom distalnog dijela radiusa imalo je 104 (26%), distalnog dijela obje kosti podlaktice 104 (26%), a prijelom dijafize obje kosti 94 (23,6%) djece. Vodeći način nastanka prijeloma u skupini naše djece je pad. Tako u njih 94 (23,1%) pad je bio u razini tla, a u 55 (13,8%) pad s male visine. Pretežite aktivnosti tijekom kojih su nastali prijelomi su rekreacija i sport, 274 djece (68,7%). Od toga na igralištu/u parku je nastalo 69 prijeloma (26,2%), vozeći bicikl 54 (19,7%) i tijekom igranja nogometa 46 (16,8%). Od 69 djece koja su zadobila prijelome podlaktice na igralištu ili u parku, 39 djece (56,5%) zadobilo je prijelome u igri u parku; ljuljačke, tobogan, trampolin. Dječaci češće padaju, gotovo tri puta u razini, dva puta s male visine u odnosu na djevojčice. Djevojčice češće ozljede zadobiju padom s koturaljki. Prosječno, bolničko liječenje u skupini naše djece je bilo 2,8 dana, a najveća pojavnost je tijekom proljeća, potom i ljeta. Temeljem rezultata ovog istraživanja, dječaci su višestruko češće ugroženi, a dominantan način ozljeđivanja je pad. Pretežito se radi o djeci predškolske i rane školske dobi. Posebite aktivnosti društvena zajednica treba usmjeriti upravo na tu djecu tijekom njihovih rekreativnih i sportskih aktivnosti (vožnja bicikla i igra nogometa). U nas su dječja igrališta i parkovi najčešća mjesta prijeloma podlaktice u djece.The forearm (radius and/or ulna) fractures are the most common fractures of childhood. One third of all fractures are radial fractures in the distal part. The fall on the extended arm is the main mechanism of injury. The diagnosis is based on anamnesis, physical status and x-ray image. The treatment procedure mostly consists of fracture repositioning and arm immobilization. The high incidence, and the possible poor outcomes of treatment, justifies the questioning of preventative measures in the occurrence of these injuries in children. For successful prevention, it is necessary to know the places and ways of the fracturing. The aim of this study is to investigate the sites and ways of the fracturing the forearm in the children living in Zagreb. In a tested analysis 395 children with forearm bone fracture were treated (hospital and outpatient) at UHC - Zagreb in the period from January 1st 2014 to October 19th 2017. The examined group consisted of 265 boys (67.1%) and 130 girls (32.9%). The average age was 9.1 years. Girls were on average younger than boys; approximately 16 months. The majority of children was 5-9 years old, 175 (44.3%) of them. There were 104 (26%) children with isolated distal part of the radius, 104 (26%) with distal parts of both forearm and the 96 (23.6%) children with diaphyseal fractures. The leading cause of fractures in our children's group is falling. Thus in 94 (23.1%) the fall was at ground level, and in 55 (13.8%) was low height fall. Activities during which fractures usually occurred were recreation and sports, 274 children (68.7%). Of this, there were 69 fractures (26.2%) while playing in the park, 54 (19.7%) while riding bicycles and 46 (16.8%) while playing football. Out of 69 children who had had a forearm fracture on the playground or in the park, 39 children (56.5%) experienced the fall in the park play; including swings, slides, and trampoline. Boys fall more often than girls, almost three times more in the ground level, and twice time more from small height. Girls are more likely to get injured by a fall from roller-skates. On average, hospital care in our group of children lasted for 2.8 days. The biggest occurrence is during spring, then during summer. Based on the results of this research, boys are more likely to be threatened with such injuries, and the dominant mode of injury is falling. Mostly, the patients are children of pre-school and early school age. Community should focus on those children during their recreational and sporting activities (cycling and football). Children's playgrounds and parks are the most common places of the forearm fractures in children