Skeletal injuries in children presenting in a tertiary health facility in Lagos state, Nigeria

Abstract

BACKGROUND: Injury remains a major health problem for children worldwide. Traumatic injuries cause substantial mortality and morbidity with temporary or permanent disability in children
METHODS: This was a prospective observational hospital based study conducted on all the patients aged 16 years and below who presented in the Accident and Emergency room and at the orthopaedic outpatient clinics in the Lagos University Teaching Hospital (LUTH) with musculoskeletal injuries over a period of fifteen months. All patients who met the inclusion criteria were recruited. Questionnaires were used for data collection. Thorough examination of the injured paediatric patient was done and finding documented in the questionnaire. Fractures of long bones were confirmed in all cases with radiographs. Data obtained was analyzed with Microsoft Excel Starter 2010 by Microsoft Corporation. Redmond, Washington.
RESULTS: The age ranged from 4 day (0.01 year) to 16 year with a mean age of6.35± 4.58. Male to Female ratio was 1.9:1. Road traffic accidents were the leading cause of skeletal injuries (49.2%), followed by falls (27.0%). Fractures associated with birth trauma accounted for 12.7%. Younger children were more prone to injuries from falls. The home environment was the second most common environment for children to sustain fractures, the first being the roads. Majority (58.7%) were from families within the lower socioeconomic class. Ninety five percent (95%) of the children who got injured were without adult supervision while crossing the road. Injuries from road traffic accidents peaked between 3pm and 6pm while injuries resulting from falls peaked between 12 noon and 3pm.The femur was the most commonly fractured bone (21.7%). Green stick fractures occurred in 7.9% of the patients seen. Open fractures were seen in 6.3% of the patients. Physeal injuries occurred in 4.8% of paediatric fractures. Some injured paediatric patients (12.3%) were taken to the traditional bone setters prior to presentation at LUTH with 3(4.7%) of them presenting with gangrene of the affected limb.
CONCLUSION: Road traffic accident remains the commonest cause of fractures in children. However, injuries sustained at the home environment were quite significant. Emphasis on increase supervision and safety practices at home are strongly recommended.

KEY WORDS: Paediatric fracture, limb gangrene, road traffic injuries, mechanism of injury, birth trauma