Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

doi:10.21203/rs.3.rs-4597527/v1

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Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

https://doi.org/10.21203/rs.3.rs-4597527/v1

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published 13 Nov, 2024

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Purpose: To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in Chinese children to provide a theoretical basis for reducing the incidence of such fractures.

Methods: A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (＜2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12-18 years).

Results: This study included 10,808 pediatric patients (7,152 males, 3,656 females). The proportion of preschool children of lower limb and pelvic fractures is the highest. Of the total patients, 14, 398 had lower limb and pelvic fracture sites. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9,599 underwent surgery, while 1,209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Concomitant trauma to other systems, in 1,806 cases, had respiratory trauma as the most common; the top three conditions were pulmonary contusions, traumatic pneumonia, and pneumothorax. Concomitant nervous system trauma had scalp hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage as the top three conditions. Concomitant digestive trauma had traumatic liver, splenic, and pancreatic injuries as the top three conditions. Concomitant urinary trauma had traumatic renal, urethral, and perineal injuries as the top three conditions. Concomitant circulatory trauma was in 36 cases.

Conclusion: The epidemiological characteristics of lower-limb and pelvic fractures in children provide valuable information. Implementing appropriate and effective preventive measures is crucial for preventing the occurrence of lower limb and pelvic fractures in children. The treatment and management of pelvic fractures and the associated multi-system injuries resulting from high-energy trauma in children require interdisciplinary teamwork to minimize the risk of mortality in the affected children.

Health sciences/Health care/Disease prevention

Health sciences/Health care/Paediatrics

Health sciences/Health care/Patient education

Health sciences/Health care/Public health

children

injury

lower limb

pelvic fracture

concomitant trauma

Unintentional childhood injuries have become a primary global public health concern, with a significant number of children and adolescents succumbing to accidental injuries worldwide(1). Fractures are the most common type of unintentional injuries in children, accounting for 10–25% (2), with an increasing incidence of childhood fractures as they grow (3). In addition, among patients of various age groups with lower limb fractures, children and adolescents account for approximately 19.2% (4), with potential consequences leading to higher mortality rates in children (5, 6). Childhood fracture types vary according to local climate, culture, and recreational activities, resulting in diverse causative factors for fractures in different countries or regions within a country (7, 8). Sweden reported that 19.5% of childhood fractures occurred in the lower limbs (5). Similarly, in Switzerland, among 2716 patients (60% male), there were 2840 cases of long bone fractures, with tibia, fibula, and femur fractures accounting for approximately 20% (9).

In addition, trauma leading to pediatric pelvic fractures is rare, occurring only in 0.5–7.0% of children (10–13). For immature skeletal structures in children, pelvic fractures typically occur following high-energy impacts such as traffic accidents or falling from a height. In such cases, the injuries will likely extend to other body parts. Therefore, surgeons treating pediatric pelvic fractures should be vigilant about concomitant trauma extending to other systems, including the abdomen, genitourinary system, spine, or head (14). However, there is currently limited research on lower limb and pelvic fracture-associated injuries in children.

China has the second largest children population globally, accounting for 12.9% (15). Consequently, research on the overall patterns and trends of lower limb and pelvic fractures in Chinese children and adolescents is limited. We conducted a retrospective analysis of epidemiological surveys of lower limb and pelvic fractures in children from 27 tertiary pediatric hospitals in China. This study aimed to provide a scientific basis for developing targeted preventive and therapeutic measures to reduce the occurrence of lower limb and pelvic fractures in children, enhance the treatment efficiency for fractures accompanied by multi-system injuries, and improve children’s overall quality of life.

We conducted a retrospective analysis of the medical records of hospitalized children with lower limb and pelvic fractures at the FuTang Research Center for Pediatric Development (FRCPD) (16, 17) in 27 tertiary children's hospitals in China between December 1, 2015, and December 31, 2019. Using the International Statistical Classification of Diseases and Related Health Problems coding 10, we collected data on age, sex, causes of injury, fracture sites, treatment modalities, concomitant trauma to other systems, the season of hospital visits, and region, from the medical record index of pediatric inpatients with lower limb and pelvic fractures.

We categorized all enrolled patients into the following age groups: Infants (<2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12–18 years), the causes of fractures were classified based on the injury mechanism: falling over, falling from a height, traffic accidents, being struck or hit, other reasons, and unknown reasons(18).

The fracture sites were anatomically classified into the patella, proximal fibula, fibula shaft, distal fibula, proximal tibia, tibia shaft, distal tibia, proximal femur, femur shaft, distal femur, and pelvis (including the ilium, pubis, ischium, sacrum, and acetabulum).

Concomitant systemic trauma was divided into nervous, respiratory, digestive, urinary, and circulatory system traumas.

Based on the admission time of the pediatric patients, hospitalized individuals were categorized into one of the four seasons: Spring, Summer, Autumn, and Winter. According to the geographical regions where fractures occurred, hospitalized patients were classified into seven geographical areas: East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi), Northwest China (Gansu, Qinghai, Xinjiang Uygur Autonomous Region, and Shaanxi), North China (Hebei, Shanxi, and Beijing), Southwest China (Guizhou and Yunnan), Northeast China (Jilin and Liaoning), and Central South China (Hunan, Guangxi Zhuang Autonomous Region, Guangdong, Hubei, and Henan).

Age and sex

In total, 10,808 pediatric patients were included in this study, with 7,152 males and 3,656 females. In all age groups, the number of males exceeded that of females. The preschool children and infants had the highest and lowest incidences of fractures, respectively. Among the pediatric patients in the four age groups, the infant group had 1,562 individuals with fractures, including 965 males and 597 females. Fracture incidence gradually increased with age, with the highest occurrence in the preschool children group, accounting for 3,720 individuals (2,419 males and 1,301 females). Subsequently, the number of fractures decreased, with 3,144 individuals in the school children group, including 1,948 males and 1,196 females, and a further decline in the adolescent group, accounting for 2,382 individuals, including 1,820 males and 562 females. The sex ratio difference in fractures increased with age, where the male-to-female ratio was 4:1 (Table 1), with the most significant difference in the adolescent group.

Table 1

Demographics of patients with 10808 fractures
Parameter		Patients n(%)
Numbers	10808
Age class
Infants	1562(15%)
Preschool children	3720(34%)
School children	3144(29%)
Adolescents	2382(22%)
Sex
Female	3656(%)
Male	7152(%)
Season
Spring	2861(%)
Summer	2824(%)
Autumn	2955(%)
Winter	2168(%)

Fracture site and treatment

Among the 10,808 pediatric patients, there were 14,398 lower limb and pelvic fracture sites. The most common fracture sites were the femur shaft (3,893 cases: 2,594 males and 1,299 females). Subsequently, fractures of the tibial shaft (3,058 cases), fibular shaft (2,061 cases), distal tibia (2,026 cases), and distal fibula (994 cases) were observed. There were 734 cases of pelvic fractures, including 25 acetabular fractures, 208 iliac, 151 pubic, 74 ischial, and 55 sacral bone fractures, and 221 unknown fractures. Proximal femur fractures occurred in 705 patients, distal femur fractures in 446, proximal tibia fractures in 325, patellar fractures in 152, and proximal fibular fractures in four patients (Figs. 1 and 2).

Femur shaft fracture was most common in preschool children (1,699 cases), followed by infants (1,139 cases), school children (793 cases), and adolescents (at least 262 fractures). The tibia shaft fracture was most common in preschool children (1163 cases), followed by 1121cases in schoolchildren, 609 cases in adolescents and 165 cases in infants. For fractures of the fibula shaft, it was most common in school children (812 cases), preschool children (718 cases), adolescents (438 cases), and infants (93 cases). Distal tibia fracture was most common in adolescents (816 cases), school children (728 cases), preschool children (409 cases), and at least 73 cases in infants. For the 734 pelvic fracture cases, the most common age group was preschool children (267 cases), followed by adolescents (218 cases), school children (157 cases), and infants (92 cases) (Table 2).

Table 2

The epidemiology of age group according to different fractures sites
Fractures sites	Infants	Preschool children	School children	Adolcent
Patella	0	3	82	67
Proximal fibula	0	1	1	2
Shaft of fibula	93	718	812	438
Distal fibula	28	226	339	401
Proximal tibia	25	37	80	183
Shaft of tibia	165	1163	1121	609
Distal tibia	73	409	728	816
Proximal femur	61	215	201	228
Shaft of femur	1139	1699	793	262
Distal femur	93	169	106	78
Pelvis	92	267	157	218

Among the included 10,808 children, 9,599 underwent surgery, while 1,209 were treated with non-surgical therapy. The ratio of surgical to non-surgical treatments was 8:1. Of the 9,599 children who underwent surgery, 4,781 underwent open reduction, and 4,818 underwent closed reduction. The treatment ratio between open and closed reductions was 1:1.

Cause of injury

In children with lower limb and pelvic fractures, the leading cause of injury was falling over in 4629 children, followed by traffic accidents in 3434 children, falling from a height in 1115 children, other and unknown reasons in 573 children, and being struck or hit in 484 children. Regarding the common causes of injuries in the different age groups, the most common cause of lower limb and pelvic fractures among children in the infant, school child, and adolescent groups was falling over, and the most common cause of injury in the preschool children group was traffic accidents (Table 3).

Table 3

The epidemiology of age group according to different etiologies
Cause of injury	Infants	Preschool children	School children	Adolescents
Falling over	780	1205	1300	1344
Falling from a height	165	413	282	255
Traffic accident	345	1553	1118	418
Being struck or hit	84	219	132	49
Other reasons	81	114	142	236
Unknown	107	216	170	80

For falling over, the adolescents had the most significant number (1344 cases), including 1039 males and 305 females, followed by the school children (1300 cases), 780 males and 520 females, and the preschool children (1205 cases), 770 males and 435 females. In the infant group, at least 780 children were injured due to falls, including 504 males and 276 females.

Second, traffic accidents (3434 cases), including 2235 males and 1199 females, was the second-largest cause of injury. The Preschool children group had the most children (1553 cases), followed by the school children group (1118 cases), the adolescent group (418 cases), and the infant group with the smallest number of children with injuries due to traffic accidents (345 cases).

There were 1115 cases, 739 males and 376 females of high-energy injuries from falling from a height. Among them, preschool children had the most significant number of 413 cases. There were 282 cases in the school children group and 255 in the adolescent group. Similarly, the infant group had the lowest number of children whose injuries were caused by falling from a height (165 cases).

Concomitant trauma

Among the 10,808 children with lower limb and pelvic fractures, 1,806 presented with concomitant trauma to other systems. Among them, concomitant respiratory trauma was the most common, with 721 cases; concomitant nervous trauma occurred in 539 cases, concomitant digestive trauma (260 cases), concomitant urinary trauma (250 cases), and concomitant circulatory trauma was observed in 36 cases (Tables 4–7).

Table 4

Concomitant nervous injury and complication
Parameter	Patients number
Scalp hematoma	212
Intracerebral hemorrhage	94
Subarachnoid hemorrhage	54
Traumatic paralysis	45
Subdural hemorrhag	39
Epidural hemorrhage	36
Cerebellar contusion injury	16
Cerebral contusion injury	13
Concussion	8
Diffuse axonal injury	7
Brain nerve injury	4
Intracranial sinus injury	3
Brain death	3
Epilepsy	2
Brainstem injury	1
Diffuse cerebellar injury	1

Table 5

Concomitant respiratory system injury and complication
Parameter	Patients number
Pulmonary contusion	384
Traumatic pneumonia	164
Traumatic pneumothorax	78
Traumatic pleural effusion	48
Traumatic hemothorax	19
Pulmonary hemorrhage	11
Respiratory failure	6
Mediastinal emphysema	5
Traumatic pulmonary rupture	3
Traumatic asphyxia	1
Pulmonary embolism	1
Acute Respiratory Distress Syndrome (ARDS)	1

Table 6

Concomitant digestive system injury and complication
Parameter	Patients number
Traumatic liver injury	144
Traumatic splenic injury	57
Traumatic pancreatic injury	23
Traumatic gallbladder injury	16
Traumatic small bowel injury	11
Traumatic colon injury	3
Traumatic anal injury	2
Traumatic gastric injury	2
Stress-related gastrointestinal bleeding	1
Traumatic retroperitoneal hematoma	1

Table 7

Concomitant urinary and circulatory system injury and complication
Parameter	Patients number
Urinary system
Traumatic renal injury	69
Traumatic urethral injury	53
Traumatic perineal injury	48
Traumatic genital injury	28
Traumatic bladder injury	25
Traumatic adrenal injury	14
Urinary tract infection	7
Renal hydronephrosis	5
Traumatic ureteral injury	1
Circulatory system
Traumatic myocardial injury	36

Regarding the most common concomitant respiratory trauma, the top five were pulmonary contusion (384 cases), traumatic pneumonia (164 cases), pneumothorax (78 cases), pleural effusion (48 cases), and hemothorax (19 cases). The top five cases of concomitant nervous trauma were scalp hematoma (212 cases), intracerebral hemorrhage (94 cases), subarachnoid hemorrhage (54 cases), traumatic paralysis (45 cases), and subdural hemorrhage (39 cases). There were 260 cases of concomitant digestive trauma; the top five were traumatic liver (144 cases), splenic (57 cases), pancreatic (23 cases), and gallbladder (16 cases) injuries and minor bowel injuries (11 cases). There were 250 cases of concomitant urinary trauma, of which the top five were traumatic renal (69 cases), urethral (53 cases), peripheral (48 cases), genital (28 cases), and bladder (25 cases) injuries. In addition, 36 patients had concomitant circulatory trauma (Fig. 3).

Monthly distribution of injuries in children with fractures

A retrospective analysis of the months in which 10,808 children with lower limb and pelvic fractures were hospitalized showed that the peak time of admission was in autumn (August-October), with 2,955 cases, and the highest peak (1,073 cases) was in October. There were 2,861 fractures in spring (February–April); the highest number was in April (975 cases). In summer (May–July), there were 2,824 patients, and the maximum number of fractures in May was 1,053. In winter (November–January), there were 2,168 people, and the maximum number of fractures in November was 880.

Geographical distribution of children with fractures

Among the 10,808 children with lower limb and pelvic fractures, East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi provinces) had the most significant number of fractures, with 5,584 children. These were followed by the central and southern regions (Hunan Province, Guangxi Zhuang Autonomous Region, Guangdong Province, Hubei Province, and Henan Province) with 5,221 people, North China (Hebei Province, Shanxi Province, and Beijing City) with 845 people, the northwest region (Gansu Province, Qinghai Province, Xinjiang Uygur Autonomous Region, and Shaanxi Province) with 809 people, the southwest region (Guizhou Province, Yunnan Province) with 518 people, and the northeast region (Jilin Province, Liaoning Province) with 501 people (Table 8).

Table 8

Distribution of injury in the region
Parameter	Patients number
East China	5584
Central and Southern China	2551
North China	845
Northwest China	809
Southwest China	518
Northeast China	501

Currently, there are few studies on the overall pattern and prevalence of lower limb and pelvic fractures in Chinese children and adolescents and the concomitant trauma to other systems with lower limb and pelvic fractures in children due to high-energy trauma. This study found that (1) the number of males among hospitalized children with fractures of all ages was higher than that of females for lower limb and pelvic fractures in children, and the number of children in the preschool age group was the highest. (2) For lower limb and pelvic fractures in children, the most common fracture site was the femur shaft, with 2594 cases in males and 1299 cases in females. (3) The most common age group for pelvic fractures was preschool children. (4) The characteristics of common fracture sites differed in different age groups; the femur shaft was the most common lower limb fracture site in the infant (1139 sites) and preschool children groups (1669 sites). The tibial shaft was the most common lower limb fracture site in the schoolchildren (1121 sites) and adolescent groups (609 sites). (5) For children with lower limb and pelvic fractures, surgery is the primary treatment, and the ratio of surgical to non-surgical treatment is 8:1. For surgical treatment, the ratio between the open and closed reductions was 1:1. (6) For lower limb and pelvic fractures in children, the most common cause of injury was falling over. (7) Among the 10,808 patients who experienced lower limb and pelvic fractures due to concomitant trauma to other systems, concomitant respiratory trauma was the most common, with pulmonary contusion accounting for the highest proportion (53.26%).

Age and Sex

One study reported that 2,473 children and adolescents aged < 18 years with traumatic fractures were studied over 10 years and observed 936 lower limb fractures (37.8%). In addition, 473 of the 936 lower limb fractures (50.0%) accounted for the most significant proportion in the 12–18-year-old age group, and in all age groups, the number of males exceeded that of females (9). Similarly, an Israeli study reported that the peak number of female fractures occurred between ages 10 and 11 years, and the peak number of male fractures occurred between ages 12 and 13 years. In addition, the number of fractures in males was more significant than that in females in all age groups (19). In addition, a United States study reported that the peak incidence of fractures in children occurred between ages 10 and 14 years (20).

In contrast with the current research results, we found that the most common age group for lower limb and pelvic fractures in children was the Preschool children group aged 2–5 years, and in all age groups, the number of male children was higher than that of female children. This study’s results are consistent with those of previous studies (18, 21–23). Males are naturally active and curious and prefer high-risk outdoor activities. Therefore, even if male children have stronger bones, the incidence of lower limb and pelvic fractures is higher than that in female children of all ages. Therefore, monitoring and prevention efforts should be strengthened for males, particularly children aged 2–5 years.

Fracture site and fracture season

The tibial shaft is the most common fracture site in the lower extremity regions (24–26). However, a study in Saudi Arabia showed that among 217 children with lower limb fractures, 141, 47, and 50 had femoral, tibial, and pelvic fractures, respectively. (27). Studies have also reported that the femur (25.9%) is the most common site of lower limb fractures in children (28). In addition, the proportion of fractures in various parts of the lower limbs changes with increasing age, with the proportion of femoral fractures decreasing from 65.2–34.5% (29, 30). Other epidemiological studies reported similar rates of femoral fractures in children (29). This finding is consistent with the results of the present study. The most common fracture site among children with lower limb and pelvic fractures was the femur shaft, followed by the tibia shaft. In addition, the incidence of femoral shaft fractures decreased with age, except in the infant group. The preschool children had the most significantly higher number of fractures. Children in this age group often ignore their surroundings due to their lively and active nature. They are prone to risky behaviors during play or activities due to the environment’s potentially hazardous nature. These behaviors may involve high-risk activities such as jumping, climbing, and running, which increase the risk of injury (31), especially if there is insufficient supervision and guidance. In particular, the lack of safety guidance from schools or community education results in a lack of the ability to identify and avoid potential dangers. In addition, consistent with our results, the most common season for lower limb fractures was autumn (August to October) (9). Therefore, the results of this study indicate that outdoor sports activities, short-term travels, and recreational plays are the most common occurrences in autumn. Therefore, excellent seasons and times for activity tend to increase the risk of lower limb and pelvic fracture traumas.

Cause of injury

Fractures in children can be caused by various injury mechanisms, such as sprains, falls from bed height or below (< 1 m), falls from stairs or slopes, blunt trauma, sports injuries, and traffic accidents (32). A Chinese study reported that the common causes of lower limb fractures in children are motor vehicle accidents (47%) and falls (26%), followed by falls from heights (15%) and injury from a hit (4.4%). In addition, motor vehicle accidents (47%) were the most common cause of injury among all age groups and children of both sexes(33). Similarly, the most common cause of lower limb fractures in children was car accidents, followed by falls (34). A study conducted in the United States reported that two-thirds of injuries were caused by motor vehicle accidents and falls, with falls being more common in younger children and motor vehicle accidents in older children (35).

In contrast to our research results, falling over was the leading cause of lower limb and pelvic fractures in children, followed by traffic accidents. In addition, for children in the infant, school, and adolescent groups, the most common cause of lower limb fractures was falling over, and the most common cause of injury in the preschool children group was traffic accidents. Regarding fracture patterns of the lower limbs and pelvis in children of different ages, there were differences in injury causes. Therefore, targeted preventive interventions based on the specific characteristics of each age group should be developed urgently to reduce the occurrence and related burden of lower limb and pelvic fractures in children, considering the characteristics of each age group and the exposure risks in daily activities in the design of personalized, scientific and effective prevention strategies.

Pelvic fractures and Concomitant trauma

A few studies have investigated the impact of pelvic fractures in children. The anatomical and biological characteristics of the pelvis in children are significantly different from those in adults. In children, the bones are more flexible and mineralized. This makes them relatively less likely to fracture when exposed to stress (36). We collected data on 734 pelvic fractures in children and adolescents. The top three fracture locations were iliac (208), pubic (151), and ischial (74) areas. In addition, studies have pointed out that the incidence of pelvic fractures is higher in older children. As children grow older, their bones become more mineralized, challenging, and fragile. However, in the present study, pelvic fractures were lower in the adolescent group than in the preschool group. This may be because increased age in older children positively impacts their risk perception and coping ability, making them more vulnerable to potential dangers. Precautions should also be taken independently to reduce the occurrence of pelvic fractures.

In addition, in skeletally immature children, pelvic fractures, which usually occur after a sustained high-energy impact such as a car accident or a fall from a height, are likely to be transmitted to other parts of the body. When children present with complaints of lower limb and pelvic fracture injuries, surgeons should be aware of concomitant trauma to other systems, including the abdomen, genitourinary system, spine, or head (14). Similarly, the genitourinary system is more likely to be injured after trauma than any other area. Pelvic fracture is accompanied by hematuria, dysuria, and urinary retention (37, 38). Children's organs, such as the kidneys, that are more important than other body parts, and the fat around the waist is underdeveloped and does not cushion injuries well (39). The incidence of urinary tract or bladder injury is 1.5–3.7% in patients with pelvic fractures (40).

However, in the present study, respiratory trauma was the most common concomitant systemic trauma in patients with pelvic fractures. Therefore, in children with pelvic fractures due to high-energy trauma, a first examining physician should perform a detailed respiratory physical examination. For children with suspected pulmonary contusions or traumatic pneumothorax, comprehensive computed tomography scan and other imaging examinations should be performed to ensure a timely and accurate diagnosis of respiratory system injuries. For children with confirmed respiratory system injuries, timely and effective treatment methods such as tracheal intubation, mechanical ventilation, and chest drainage are vital to ensure adequate oxygenation and ventilation. This series of measures is crucial to prevent the progression of respiratory system complications, help slow the development of complications to the greatest extent and improve children's recovery and survival rates.

We should strengthen health and safety education for children, parents, communities, and schools based on distribution characteristics such as age, sex, and causes of injuries. Protective measures for children’s activities should also be increased. The incidence of lower limb fractures in children can be reduced and healthy growth through comprehensive intervention measures can be ensured.

High-energy trauma in children resulting in pelvic fractures and concomitant multi-system injuries is challenging, and its treatment and management require interdisciplinary teamwork. Therefore, comprehensive and individualized treatment plans for pelvic fractures and multi-system accompanying injuries due to high-energy trauma in children through close cooperation should be provided among pediatric orthopedics, critical care medicine, pediatric surgery, pediatric internal medicine, and other specialties, minimizing the risk of death in children.

Ethics approval and consent to participate

This study was carried out in full compliance with the Declaration of Helsinki. This study has been approved by the Medical Ethics Committee of the Shenzhen Children’s Hospital (No. 202000302). All patients and their legal guardian/Parents voluntarily participated and signed the informed consent form.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Competing interests

The authors declare no affiliation with or financial involvement in organizations or entities with a direct financial interest in the subject matter or materials discussed in the manuscript.

Funding

This study was supported by Guangdong High-level Hospital Construction Fund and Sanming Project of Medicine in Shenzhen (SZSM202011012).

Author Contributions

Xin Qiu, Tianfeng Zhu, Hansheng Deng, Jianlin Chen and Haoran Feng conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Xin Qiu, Guoshuang Feng, Leonardo Antonio Sechi, Gianfilippo Caggiari, Chao You and Guibing Fu designed the data collection instruments, coordinated and supervised data collection and critically reviewed the manuscript. Zilong Huang, Jiahui Li, Xinyu Wang, Shizhe Liu, Shuaiyin Wang, Zhenkun Gu, Zhengyu Wu, Qisong Yang and Gen Liu collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Acknowledgments：

The authors thank the staff members of Futang Research Centre of Pediatric Development (FRCPD) for their help and collaboration.

List of investigators and members of Futang Research Centre of Pediatric development(FRCPD)

Yueping Zeng, Jian Tian, Fei Song, Xin Xu — Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China; Mei Wu — Medical Record Department, Anhui Children’s Hospital, Hefei, China; Guosong Wang — Information Centre, Anhui Children’s Hospital, Hefei, China; Li Li — Medical Record Department, Dalian Children’s Hospital, Dalian, China; Hongjie Sun — Information Department, Dalian Children’s Hospital, Dalian, China; Zhenqiang Da —Medical Record Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; WenJuan Wang — Information Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; Qinghong He — Medical Record Department, Guiyang Children’s Hospital, Guiyang, China; Shaoqian Liu — Information Centre, Guiyang Children’s Hospital, Guiyang, China; Ling Dai — Information Department, Hangzhou Children’s Hospital,Hangzhou, China; Waiguang Hu — Information Centre, Hunan Children’s Hospital, Hangzhou,China; Xiaomei Chen — Medical Record Department,Inner Mongolia Children’s Hospital, Hohhot, China;Xiaoqin Wang, Jian Du — Information Department,Inner Mongolia Children’s Hospital, Hohhot, China;Chunxiang Wang — Medical Record Department,Jinan Children’s Hospital, Jinan, China; Yuanyi Qu — Information Department, Jinan Children’s Hospital, Jinan, China; Daqiao Zhu — Medical Record Department, Kunming Children’s Hospital, Kunming,China; Jian Ding — Information Department, Kunming Children’s Hospital, Kunming, China; HaibinZhou — Medical Record Department, Liaocheng Children’s Hospital, Liaocheng, China; Jinchi Shi — Information Department, Liaocheng Children’s Hospital,Liaocheng, China; Zhijun Pan — Medical Record Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Lei Yang — Information Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Tingting Zhang — Medical Record Department, Nanjing Children’s Hospital, Nanjing, China; Jin Xu — Information Department, Nanjing Children’s Hospital, Nanjing, China; Lianjun Ruan — Medical Record Department, Qinghai Children’s Hospital, Xining, China; Shu Mai —Information Department, Qinghai Children’s Hospital, Xining, China; Fengmei Ma — Department of quality control, Qinghai Children’s Hospital, Xining, China; Li Gao — Medical Record Department, Shanxi Children’s Hospital, Taiyuan, China; Hongcheng Liu — Information Centre, Shanxi Children’s Hospital, Taiyuan, China; Xirong Chen — Medical Record Department, Shenzhen Children’s Hospital, Shenzhen, China; Yuzheng Zhang — Information Department, Shenzhen Children’s Hospital, Shenzhen, China; Jun Zhou — Medical Record Department, Urumqi Children’s Hospital, Urumqi, China; ChunXiang Yan — Medical Record Department, Wuhan Children’s Hospital, Wuhan, China; Jian Fang —Information Centre, Wuhan Children’s Hospital, Wuhan, China.

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No competing interests reported.

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Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Materials and Methods

Results

Age and sex

Fracture site and treatment

Cause of injury

Concomitant trauma

Monthly distribution of injuries in children with fractures

Geographical distribution of children with fractures

Discussion

Age and Sex

Fracture site and fracture season

Cause of injury

Pelvic fractures and Concomitant trauma

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1