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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 61-63

Distribution of elbow injuries among children 3-13 years of age in North-West India


1 Department of Orthopedics, Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, Himachal Pradesh, India
2 Department of Community Medicine, Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, Himachal Pradesh, India
3 Department of Radiodiagnosis, Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, Himachal Pradesh, India

Date of Web Publication17-Dec-2015

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, Himachal Pradesh
India
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DOI: 10.4103/1119-0388.172070

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  Abstract 

Introduction: Pediatric elbow fractures have both a higher incidence and a greater variability in fracture patterns as compared with adults. Materials and Methods: All patients aged 3-13 years presenting to the department of orthopedics with injuries around the elbow joint and fulfilling the inclusion criteria were included in the study. Results: Elbow injuries are more common in male children (n = 88, 70.4%). Further elbow injuries on the left arm are more common. Conclusion: Understanding the agewise distribution of fractures among children will help us to plan prevention.

Keywords: Children, distribution, elbow injuries


How to cite this article:
Awasthi B, Raina SK, Chauhan N, Sehgal M, Sharma V, Thakur L. Distribution of elbow injuries among children 3-13 years of age in North-West India. Trop J Med Res 2016;19:61-3

How to cite this URL:
Awasthi B, Raina SK, Chauhan N, Sehgal M, Sharma V, Thakur L. Distribution of elbow injuries among children 3-13 years of age in North-West India. Trop J Med Res [serial online] 2016 [cited 2019 Jul 18];19:61-3. Available from: http://www.tjmrjournal.org/text.asp?2016/19/1/61/172070


  Introduction Top


Trauma to the child's elbow may result in bony, cartilaginous, or soft tissue injury. Just like adults, children instinctively protect their central core from a fall with their arms outstretched and hence, tend to break their bone in a similar form. Epidemiological studies have shown that pediatric elbow fractures have both a higher incidence and a greater variability in fracture patterns as compared with adults.[1] Overall, 65-75% of all fractures in children occur in the upper extremity,[2] with supracondylar fractures accounting for 60% among these.[3] This area of the bone is relatively weak due to the metaphyseal remodeling that takes place during the first 10 years of development and therefore, the incidence of this injury peaks at 5-8 years of age.[4] The number of elbow injuries continues to rise following increased levels of participation of children in recreational and competitive sports.[5]


  Materials and Methods Top


The study was conducted as a prospective, descriptive study in the department of orthopedics in a medical college located in rural northwest India. All patients aged 3-13 years presenting to the department from January 1, 2013 to December 31, 2013 (including days of emergency) with injuries around the elbow joint were included in the study except for the following cases:

  • Patients who did not give consent for participation in the study
  • Injury, either old or new, to the bilateral elbow
  • Patients with congenital deformities around the bilateral elbow joint
  • Children less than 3 years of age
  • Children above 13 years of age


Methodology

The study was conducted using a pro forma on children fulfilling the inclusion criteria. The pro forma included details on age, sex, side, and economic status of the children. The subjects were sent to radiological examination using x-rays as the investigation modality. Parental permission was sought before including children up to 7 years of age in the study, after ensuring the following:

  1. The conduct of the process in a manner and location that ensured participant privacy
  2. Giving adequate information about the study in a language understandable to the participant
  3. Providing adequate opportunity for the participant to consider all options
  4. Responding to the participant's questions
  5. Ensuring that the participant understood the information provided
  6. Obtaining the participant's voluntary agreement to participate
  7. Continuing to provide information as required by the participant or research


In the case of children above 7 years, assent from the children in addition to parental permission after fulfilling the above criteria was obtained.


  Results Top


The mean ± standard deviation (SD) age for the above data is 8 ± 2.99 years. The mean ± SD age for males is 8.3 ± 3 years and for females is 7.54 ± 2.94 years. Also, [Table 1] shows that elbow injuries are more common in males (n = 88, 70.4%). [Table 2] shows that elbow injuries are common on the left side (n = 74, 59.2%), although the results are not statistically significant. The left side involvement (5.9%) is equally common in both males and females. [Table 3] shows that elbow injuries are more common in children belonging to the above poverty line (APL) status (n = 95, 76%).
Table 1: Age and sex distribution of the studied children (3-13 years) with elbow injuries

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Table 2: Extremity involvement in the studied children

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Table 3: Economic status of the studied children with elbow injuries

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  Discussion Top


In a study on 355 African children, Houshian et al.[6] reported that the average age for elbow fractures was 7.9 years (7.2 years in boys and 8.5 years in girls). In our study, the average age of children presenting with elbow injury was 8 years (8.3 years in boys and 7.54 years in girls). The average age of elbow trauma in children remains the same as in Western studies. The age of occurrence of fractures being around 8 years may be because of the increase in outdoor activities among the children around this time of life. On the basis of various studies, Rockwood and Wilkins [7] claimed that the incidence of elbow injuries and supracondylar fractures in male children was two to three times more than in female children.

Also, in our study 70.4% subjects sustaining injury to the elbow were males and 29.6% were females a fact that supports the above statement. Injuries on the nondominant extremity or the left side (60.8%) were seen to predominate in children with elbow trauma, as mentioned in Rockwood and Wilkins' textbook on orthopedics.[7] In our study, the left side was involved in 59.8% of the cases, which was similar to other studies. The available literature has not mentioned a correlation between elbow injuries in children and their socioeconomic status.

In our study, 76% of the cases presenting with trauma to the elbow belonged to the APL status. Increased awareness, easy accessibility to medical services, and increased involvement of the children belonging to the APL group in recreation activities increases the chances of encountering trauma.

 
  References Top

1.
Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med 1977;5:23-30.  Back to cited text no. 1
[PUBMED]    
2.
Rogers LF. Radiology of Skeletal Trauma. 2nd ed. New York: Churchill Livingstone; 1992. p. 749-836.  Back to cited text no. 2
    
3.
Crombie A, Duncan R. Closed reduction and percutaneous fixation of displaced paediatric supracondylar fractures of the elbow. Orthop Trauma 2004;18:147-53.  Back to cited text no. 3
    
4.
Steenbrugge F, Macnicol MF. Guidelines and pitfalls in the management of supracondylar humerus fractures in children. Cur Orthop 2001;15:214-9.  Back to cited text no. 4
    
5.
DeLee JC, Drez D Jr, Miller MD. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Pa: Saunders Elsevier; 2009: Section D.  Back to cited text no. 5
    
6.
Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: Analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 2001;6:312-5.  Back to cited text no. 6
    
7.
Wilkins KE. Fractures and dislocations of the elbow region. In: Rockwood CA, Wilkins KE, King RE, editors. Fractures in Children. Vol. 3. Philadelphia: JB Lippincott Co.; 1984. p. 363-575.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
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