Changing trends in the management of pediatric distal forearm fractures: a descriptive Danish 20-year nationwide registry study of 175,083 cases

BACKGROUND AND PURPOSE: Management of pediatric distal forearm fractures ranges from no or simple immobilization to surgical fixation. Treatment decisions depend on age and fracture severity, but practices vary widely across countries. As surgical intervention has increased internationally, we aimed to investigate national trends in incidence and treatment of pediatric distal forearm fractures in Denmark from 1999-2018 Methods: We conducted a population-based register study of children aged 0-15 with distal forearm fractures (S525 + S526) registered in the Danish National Patient Registry from 1999-2018. Treatments within 1 week of injury were grouped into: non-surgical (no immobilization, soft bandage or cast immobilization), closed reduction and immobilization, and surgical fixation. Procedure codes included closed reduction, open reduction, K-wires, or other fixations such as external fixation, nail, plate, or screws. RESULTS: There were 175,083 fractures over the 20 years, yielding a mean incidence of 829/100,000/year in children aged 0-15 years. The highest incidences were 1,494/100,000 among 11-year-old girls and 1,720/100,000 among 13-year-old boys. The primary treatment in all age groups was non-surgical treatment, though decreasing from 92% in 1999 to 89% in 2018. The proportion of closed reduction declined from 7% to 2%, while K-wire fixation increased from 1% to 8%. When stratified by age groups, the same trend was seen in all but the 0-3-year-olds. CONCLUSION: The overall incidence remained stable during the study period. Non-surgical treatment remained predominant, whereas closed reductions decreased in favor of more K-wire fixations.