Victims of our climate

doi:10.1016/0020-1383(93)90179-A

Injury

Volume 24, Issue 4, April 1993, Pages 247-248

https://doi.org/10.1016/0020-1383(93)90179-A Get rights and content

Abstract

In order to test the hypothesis that the volume of paediatric orthopaedic trauma is related to the weather, we analysed all children with fractures admitted to our unit over a 3-year period and correlated this information with local meteorological data. The average number of children admitted per month with fractures showed a strong positive correlation with mean monthly sunshine hours (Pearson correlation coefficient 0.91) and a weak negative correlation with mean monthly rainfall (−0.24). The summer peak in the incidence of fractures persisted when the effect of school holidays was eliminated. Fractures involving the radius accounted for 48.7 per cent of all fracture admissions and correlation with sunshine hours was highest in this group. Almost two-thirds of all fracture admissions were male and these had a slightly higher mean age (8.2 years) than females (7.6 years). This data has implications for bed management and staffing levels in a paediatric orthopaedic unit.

References (14)

R.P. Lichtenberg
A study of 2532 fractures in children
Am. J. Surg.
(1954)
D.M. Williamson et al.
Why do children break their arms?
Injury
(1988)
G. Hagglund et al.
Epidemiology of slipped capital femoral epiphysis in southern Sweden
Clin. Orthop.
(1984)
B. Henrikson
Supracondylar fracture of the humerus in children. A late review of end-results with special reference to the cause of deformity, disability and complications
Acta Chir. Scand.
(1966)
J. Hindmarsh et al.
Accidents in childhood
Acta Chir. Scand.
(1946)
L. Landin
Fracture patterns in children
Acta Orthop. Scand.
(1983)
R.T. Loder et al.
Seasonal variation of slipped capital femoral ephiphysis
J. Bone Joint Surg.
(1990)

There are more references available in the full text version of this article.

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In preschool children, the incidence curve was monomodal, with the highest incidence found in June to August. This could be partially explained by the increase of outdoor activities for preschool children during the summer period [26]. In contrast, in the school children, the special bimodal incidence with the highest incidence found in May (spring) and September (autumn), suggests that this pattern could possibly be explained by the association of DRFs with specific school events in this age group.
Although distal radius fracture (DRF) is the most common fracture type in children, research on its seasonality across different age groups is limited. We investigated secular trends in incidence and seasonal variation of pediatric DRF based on Swedish nationwide population database.
In this observational study, data for all children aged <18 years in Sweden with DRF defined by ICD-codes were analyzed for each month and each year during 2002–2016 using the Swedish National Patient Register. The general population counts for each age and sex-category were acquired to evaluate population at risk for each period. We calculated the age standardized and sex specific annual incidence rates, seasonal incidence rates, and monthly incidence rates and analyzed the seasonal variation in the mechanisms of injury.
A total of 155,891 DRF cases were identified. The age standardized and sex specific incidence rate was 531 (95%CI 528–533) per 100,000 patient years at risk. Fracture risk was highest during summer and lowest in the winter. The highest seasonal variation was observed among boys 2- < 5 years. The crude incidence rate and the age-standardized incidence rates in winter significantly decreased between 2002 and 2016 (annual percentage change, −2 %).
We found significant seasonal variation in DRF among all age groups in Swedish children. The findings can help in developing strategies to prevent fractures as well as in allocating medical and social resources.
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Citation Excerpt :
Overall, the seasonal pattern of fracture risk was comparable at most fracture sites within an age group, with the risk for fractures being higher in the spring and autumn for children, and higher in winter for the elderly. This age difference in risk profile intuitively makes sense, as children tend to be more physically active in the moderate weather conditions in spring and autumn [20,21]. The lower risk of fractures in children in the summer likely reflects a decrease in physical activity in the hot weather and/or a decrease in social activity during the summer holidays.
Although age- and season-specific effects on fracture risk have been reported, the effects of seasonality across different age groups and for different fracture sites have not yet been clarified. Therefore, our study aimed to comprehensively investigate the effects of seasonality on fracture risk across age and fracture sites using a large-scale population database of fracture incidence.
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Over the study period, 508,051 fractures were identified across the following five age groups: 0–19, 20–39, 40–64, 65–79, and 80+ years. The incidence rate for fractures in 10 site groups was calculated. Fracture risk was the highest in the spring and autumn for children aged 0–19 years and was the highest in the winter for elderly individuals (65–79 and 80+ years). Toe fractures, which occurred more frequently in the summer, were the most notable exception. The risk of fracture of the distal radius and hip was associated with daily temperature and rainfall and was elevated on days with a mean temperature higher than that of the previous day.
Fracture risk exhibited seasonal variations that differed between children and elderly individuals and between toe fractures and fractures at other sites. These findings can help us understand the epidemiology of fractures and develop preventive strategies, as well as aid in the allocation of healthcare resources.
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While SCF fixation is common, the rate of re-operation is low. No differences existed between the sexes and a higher volume of fixations occurred during the summer months.
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Citation Excerpt :
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The risk of forearm shaft fracture was 50% higher on dry days compared to rainy days (P = 0.038). Temperature and wind speed had no statistically significant effect on fractures.
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Excessive heat is an environmental and occupational hazard for human health. This chapter reviews current epidemiological evidence of the determinants of heat-related mortality and morbidity in high-income populations in temperate climate zones. Heat-related mortality is found in all populations studied, and population sensitivity to heat (such as the temperature at which heat risk increases) is determined, in part, from the local climate, reflecting adaptation at the population level. Several factors increase individual susceptibility to heat-related mortality, including being elderly and having a chronic illness or disability. Factors that determine exposures to high indoor temperatures depend on housing characteristics and behavior. The role of urban (outdoor) factors in determining individual risks is less well understood. In future decades, the population at risk of heat-related mortality will increase due to the expansion of the elderly population, who are at higher risk. Exposures to high outdoor temperatures may also increase from urbanization (intensification of the urban heat island effect) and climate change from greenhouse gas emissions, aerosols, and land use change. Strategies to reduce heat-related mortality include heat health warning systems and interventions to modify the built environment to reduce indoor and outdoor temperatures.
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PaperVictims of our climate

Abstract

Am. J. Surg.

Injury

Epidemiology of slipped capital femoral epiphysis in southern Sweden

Clin. Orthop.

Supracondylar fracture of the humerus in children. A late review of end-results with special reference to the cause of deformity, disability and complications

Acta Chir. Scand.

Accidents in childhood

Acta Chir. Scand.

Fracture patterns in children

Acta Orthop. Scand.

Seasonal variation of slipped capital femoral ephiphysis

J. Bone Joint Surg.

Paper
Victims of our climate