Abstract
Aim
Although non-union is a devastating and costly consequence of trauma for the child, family and society it is felt to be a rare complication in children. Currently there is no data available in the literature regarding its incidence either per fracture or per head of population. Should we be taking paediatric fracture non-union more seriously regarding research, resource allocation and informed consent? Our aim was to determine the incidence of non-union per child and per fracture.
Method
In Scotland Information Services Division (NHS Scotland) records every inpatient admission by ICD-10 diagnosis. As almost all fracture non-unions require intervention ISD provides accurate non-union figures by site and age. However, many fractures are treated as outpatients. Using local data of overall fracture numbers we were able to calculate a ratio of inpatient to total fracture numbers and apply this nationally.
Results
Over a 5-year period there were 180 cases of non-union between the ages of 0–14 years, (4.21/100,000pa) and an incidence of 15,335 fractures/100,000pa giving an overall risk of 0.24% non-union per fracture. The risk of non-union per fracture did not change throughout childhood but notably increased in the late teenage years (15–19yrs). Both the incidence of fractures and non-union were far greater in boys, however incidence of non-union per fracture was similar in both sexes in childhood. Non-union per fracture was twice as frequent in the lower than upper limb, this trend reversed in the 15–19 year age group.
Conclusion
The annual incidence of fractures in children is 15.3%, more frequent in the upper than lower limb; increasing with age, particularly in boys. The risk of non-union is around 1/400 per upper limb and 1/250 per lower limb fracture in childhood. Fracture non-union is rare in the paediatric population but even so 4.2 cases would be expected per 100,000 population or 240 cases per 100,000 fractures.
