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Abstract：
BACKGROUND: Epidemiological research on fractures in children under the age of two is of great importance to help understand differences between accidental and abusive trauma.
OBJECTIVE: This systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics.
METHODS: A systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0-2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies.
RESULTS: Twelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0-2 years of age; with commonest sites being the radius/ulna (25.2-40.0%), followed by tibia/fibula (17.3-27.6%) and the clavicle (14.6-14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50-60% of fractures.
CONCLUSIONS: There is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood.
OBJECTIVE: This systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics.
METHODS: A systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0-2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies.
RESULTS: Twelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0-2 years of age; with commonest sites being the radius/ulna (25.2-40.0%), followed by tibia/fibula (17.3-27.6%) and the clavicle (14.6-14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50-60% of fractures.
CONCLUSIONS: There is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood.
摘要：
背景：关于两岁以下儿童骨折的流行病学研究对于帮助理解意外和虐待性创伤之间的差异非常重要。
目的：本系统综述旨在评估有关两岁以下儿童骨折发生率的研究报告，不包括出生伤害。次要结果指标包括骨折位置，损伤机制和骨折特点。
方法：系统文献综述(1946年至2024年2月7日)，包括前瞻性和回顾性队列研究以及横断面队列研究，已执行。如果可以提取0-2岁儿童的实际测量值，则包括其他年龄组儿童的研究。我们还纳入了仅限于婴儿的研究。提取骨折的年发生率并报告为主要结果。使用横截面研究的评估工具进行批判性评估。
结果：12项中等至高质量的研究符合资格标准，其中7项基于病历数据，5项为注册研究。研究调查了骨折的不同方面，使综合综合具有挑战性。0-2岁儿童的年骨折发生率为5.3-9.5/1,000;最常见的部位是桡骨/尺骨(25.2-40.0%),其次是胫腓骨(17.3-27.6%)和锁骨(14.6-14.8%)(位置基于3项研究,共407例患者).在婴儿中,报告的发病率在每千名患者0.7至4.6之间(基于3项研究)，22.2％的病例涉及锁骨，22.2％的病例涉及肱骨远端（基于1项研究）。仅报告了单个干phy端病变（11个月大婴儿的肱骨近端）。在四项研究中详细介绍了骨折机制，从椅子上掉下来，bed,table,自身身高或在室内活动后跌倒，导致50-60%的骨折。
结论：缺乏关于两岁以下儿童骨折发生率的高质量数据。较大,前瞻性和无偏见的研究将有助于确定正常的伤害模式，以便更好地理解与虐待创伤的差异。
目的：本系统综述旨在评估有关两岁以下儿童骨折发生率的研究报告，不包括出生伤害。次要结果指标包括骨折位置，损伤机制和骨折特点。
方法：系统文献综述(1946年至2024年2月7日)，包括前瞻性和回顾性队列研究以及横断面队列研究，已执行。如果可以提取0-2岁儿童的实际测量值，则包括其他年龄组儿童的研究。我们还纳入了仅限于婴儿的研究。提取骨折的年发生率并报告为主要结果。使用横截面研究的评估工具进行批判性评估。
结果：12项中等至高质量的研究符合资格标准，其中7项基于病历数据，5项为注册研究。研究调查了骨折的不同方面，使综合综合具有挑战性。0-2岁儿童的年骨折发生率为5.3-9.5/1,000;最常见的部位是桡骨/尺骨(25.2-40.0%),其次是胫腓骨(17.3-27.6%)和锁骨(14.6-14.8%)(位置基于3项研究,共407例患者).在婴儿中,报告的发病率在每千名患者0.7至4.6之间(基于3项研究)，22.2％的病例涉及锁骨，22.2％的病例涉及肱骨远端（基于1项研究）。仅报告了单个干phy端病变（11个月大婴儿的肱骨近端）。在四项研究中详细介绍了骨折机制，从椅子上掉下来，bed,table,自身身高或在室内活动后跌倒，导致50-60%的骨折。
结论：缺乏关于两岁以下儿童骨折发生率的高质量数据。较大,前瞻性和无偏见的研究将有助于确定正常的伤害模式，以便更好地理解与虐待创伤的差异。
