Age and Seasonal Variation in Pediatric Fractures: An Epidemiological Study Based on 90,000 Fractures From the Swedish Fracture Register

BACKGROUND: Fractures among children and adolescents are common; however, comprehensive national studies are limited. A nationwide register-based cohort study was undertaken using data from the Swedish Fracture Register (SFR) to analyze the epidemiology of long bone fractures in children and adolescents in Sweden, including seasonal and age-related variations. METHODS: This observational study used data from the SFR. All patients aged 16 or younger with a fracture in any segment of a long bone (humerus, forearm, femur, and tibia) from May 1, 2015 to April 31, 2023 were included. Epidemiological data, including age, month of injury, sex, affected side, open or closed physis, injury type, fracture classification according to the AO Paediatric Comprehensive Classification of Long Bone Fractures (PCCF), and treatment type, were retrieved and analyzed. RESULTS: During the 8-year study period, 87,004 children with 94,347 fractures to any part of a long bone were registered in the SFR. In 2021, the overall annual incidence of long bone fractures was 133 per 10,000 children. Distal forearm fractures accounted for almost half of all fractures (n=45,355, 48%). There was a continuously increasing number of fractures with increasing age until a peak between ages 10 and 12. Fractures were most common in May to June and August to September. CONCLUSION: This study presents the epidemiology of pediatric fractures based on over 90,000 cases from the SFR. Distal forearm fractures were the most common, accounting for half of long-bone fractures in children (0-16 y). A general peak in fracture incidence was observed around the onset of puberty, with variation across fracture locations. The study also reveals a distinct seasonal variation in pediatric fractures. May to June and August to September appear to be the most common months for children and adolescents to sustain fractures in Sweden. LEVELS OF EVIDENCE: Level II-retrospective study.