An increased risk of repeated fractures could relate to the personal and family characteristics of these accident-prone children. Studies have also shown that a child with one hospital admission for an accident in the first five years of life runs an increased risk of experiencing another accident-related admission, compared with children of the same age and sex with no previous admissions for accidents. The reasons for the difference are unknown, but studies examining both the behavior of children in this age group and parent-child interactions describe greater risk taking among boys and higher parental protectiveness toward girls. Although all fracture types are more frequent in boys, such a great gender difference in this age group does not occur for other types of fractures. The incidence of femur shaft fractures for boys and girls peaks among children aged one to three years, and the incidence is three times higher among boys than among girls. The explanation might relate to factors affecting the bone quality of the lower leg. This increased fracture risk is probably not simply the result of greater risk-taking among boys. We found an increased risk for subsequent fractures in the lower leg that requires inpatient care during childhood for boys, but not for girls, who were one to three years of age when they first suffered a femur shaft fracture. Boys exhibited a 162% increased risk of suffering a lower leg fracture requiring hospital admission (HR?=?2.62, 95% CI: 1.45–4.71), but the refracture risk was not significant for girls 2.02 (0.58–6.97). ResultsĮxposed children exhibited no significantly increased risk of upper-extremity fractures or soft-tissue injuries during childhood, regardless of sex and follow-up time. Hazard ratios (HRs) and 95% confidence intervals (CIs) for severe injuries defined as fractures or soft-tissue injuries requiring hospital admission were estimated in a Cox proportional hazards model.
We compared the subsequent risk of hospitalization for injuries during childhood among 1,404 children (exposed) who were one to three years of age when they suffered a femur shaft fracture with the risk among 13,814 randomly selected, gender- and age-matched femur fracture–free children (unexposed).
The purpose of this nationwide cohort study was to estimate the association between a femur shaft fracture at a young age and the subsequent risk of hospitalization for injuries during childhood. This risk could be related to personal and family characteristics or to lower-than-average bone-mineral density. A child who suffers a fracture or a soft-tissue injury at a young age faces an increased risk of subsequent injuries during childhood.
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