Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China

Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China Xin Qiu, Tianfeng Zhu, Hansheng Deng, Jianlin Chen, Haoran Feng, and 14 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4597527/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Purpose: To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in Chinese children to provide a theoretical basis for reducing the incidence of such fractures. Methods: A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (＜2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12-18 years). Results: This study included 10,808 pediatric patients (7,152 males, 3,656 females). The proportion of preschool children of lower limb and pelvic fractures is the highest. Of the total patients, 14, 398 had lower limb and pelvic fracture sites. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9,599 underwent surgery, while 1,209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Concomitant trauma to other systems, in 1,806 cases, had respiratory trauma as the most common; the top three conditions were pulmonary contusions, traumatic pneumonia, and pneumothorax. Concomitant nervous system trauma had scalp hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage as the top three conditions. Concomitant digestive trauma had traumatic liver, splenic, and pancreatic injuries as the top three conditions. Concomitant urinary trauma had traumatic renal, urethral, and perineal injuries as the top three conditions. Concomitant circulatory trauma was in 36 cases. Conclusion: The epidemiological characteristics of lower-limb and pelvic fractures in children provide valuable information. Implementing appropriate and effective preventive measures is crucial for preventing the occurrence of lower limb and pelvic fractures in children. The treatment and management of pelvic fractures and the associated multi-system injuries resulting from high-energy trauma in children require interdisciplinary teamwork to minimize the risk of mortality in the affected children. Health sciences/Health care/Disease prevention Health sciences/Health care/Paediatrics Health sciences/Health care/Patient education Health sciences/Health care/Public health children injury lower limb pelvic fracture concomitant trauma Figures Figure 1 Figure 2 Figure 3 Introduction Unintentional childhood injuries have become a primary global public health concern, with a significant number of children and adolescents succumbing to accidental injuries worldwide( 1 ). Fractures are the most common type of unintentional injuries in children, accounting for 10–25% ( 2 ), with an increasing incidence of childhood fractures as they grow ( 3 ). In addition, among patients of various age groups with lower limb fractures, children and adolescents account for approximately 19.2% ( 4 ), with potential consequences leading to higher mortality rates in children ( 5 , 6 ). Childhood fracture types vary according to local climate, culture, and recreational activities, resulting in diverse causative factors for fractures in different countries or regions within a country ( 7 , 8 ). Sweden reported that 19.5% of childhood fractures occurred in the lower limbs ( 5 ). Similarly, in Switzerland, among 2716 patients (60% male), there were 2840 cases of long bone fractures, with tibia, fibula, and femur fractures accounting for approximately 20% ( 9 ). In addition, trauma leading to pediatric pelvic fractures is rare, occurring only in 0.5–7.0% of children ( 10 – 13 ). For immature skeletal structures in children, pelvic fractures typically occur following high-energy impacts such as traffic accidents or falling from a height. In such cases, the injuries will likely extend to other body parts. Therefore, surgeons treating pediatric pelvic fractures should be vigilant about concomitant trauma extending to other systems, including the abdomen, genitourinary system, spine, or head ( 14 ). However, there is currently limited research on lower limb and pelvic fracture-associated injuries in children. China has the second largest children population globally, accounting for 12.9% ( 15 ). Consequently, research on the overall patterns and trends of lower limb and pelvic fractures in Chinese children and adolescents is limited. We conducted a retrospective analysis of epidemiological surveys of lower limb and pelvic fractures in children from 27 tertiary pediatric hospitals in China. This study aimed to provide a scientific basis for developing targeted preventive and therapeutic measures to reduce the occurrence of lower limb and pelvic fractures in children, enhance the treatment efficiency for fractures accompanied by multi-system injuries, and improve children’s overall quality of life. Materials and Methods We conducted a retrospective analysis of the medical records of hospitalized children with lower limb and pelvic fractures at the FuTang Research Center for Pediatric Development (FRCPD) ( 16 , 17 ) in 27 tertiary children's hospitals in China between December 1, 2015, and December 31, 2019. Using the International Statistical Classification of Diseases and Related Health Problems coding 10, we collected data on age, sex, causes of injury, fracture sites, treatment modalities, concomitant trauma to other systems, the season of hospital visits, and region, from the medical record index of pediatric inpatients with lower limb and pelvic fractures. We categorized all enrolled patients into the following age groups: Infants (<2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12–18 years), the causes of fractures were classified based on the injury mechanism: falling over, falling from a height, traffic accidents, being struck or hit, other reasons, and unknown reasons( 18 ). The fracture sites were anatomically classified into the patella, proximal fibula, fibula shaft, distal fibula, proximal tibia, tibia shaft, distal tibia, proximal femur, femur shaft, distal femur, and pelvis (including the ilium, pubis, ischium, sacrum, and acetabulum). Concomitant systemic trauma was divided into nervous, respiratory, digestive, urinary, and circulatory system traumas. Based on the admission time of the pediatric patients, hospitalized individuals were categorized into one of the four seasons: Spring, Summer, Autumn, and Winter. According to the geographical regions where fractures occurred, hospitalized patients were classified into seven geographical areas: East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi), Northwest China (Gansu, Qinghai, Xinjiang Uygur Autonomous Region, and Shaanxi), North China (Hebei, Shanxi, and Beijing), Southwest China (Guizhou and Yunnan), Northeast China (Jilin and Liaoning), and Central South China (Hunan, Guangxi Zhuang Autonomous Region, Guangdong, Hubei, and Henan). Results Age and sex In total, 10,808 pediatric patients were included in this study, with 7,152 males and 3,656 females. In all age groups, the number of males exceeded that of females. The preschool children and infants had the highest and lowest incidences of fractures, respectively. Among the pediatric patients in the four age groups, the infant group had 1,562 individuals with fractures, including 965 males and 597 females. Fracture incidence gradually increased with age, with the highest occurrence in the preschool children group, accounting for 3,720 individuals (2,419 males and 1,301 females). Subsequently, the number of fractures decreased, with 3,144 individuals in the school children group, including 1,948 males and 1,196 females, and a further decline in the adolescent group, accounting for 2,382 individuals, including 1,820 males and 562 females. The sex ratio difference in fractures increased with age, where the male-to-female ratio was 4:1 (Table 1 ), with the most significant difference in the adolescent group. Table 1 Demographics of patients with 10808 fractures Parameter Patients n(%) Numbers 10808 Age class Infants 1562(15%) Preschool children 3720(34%) School children 3144(29%) Adolescents 2382(22%) Sex Female 3656(%) Male 7152(%) Season Spring 2861(%) Summer 2824(%) Autumn 2955(%) Winter 2168(%) Fracture site and treatment Among the 10,808 pediatric patients, there were 14,398 lower limb and pelvic fracture sites. The most common fracture sites were the femur shaft (3,893 cases: 2,594 males and 1,299 females). Subsequently, fractures of the tibial shaft (3,058 cases), fibular shaft (2,061 cases), distal tibia (2,026 cases), and distal fibula (994 cases) were observed. There were 734 cases of pelvic fractures, including 25 acetabular fractures, 208 iliac, 151 pubic, 74 ischial, and 55 sacral bone fractures, and 221 unknown fractures. Proximal femur fractures occurred in 705 patients, distal femur fractures in 446, proximal tibia fractures in 325, patellar fractures in 152, and proximal fibular fractures in four patients (Figs. 1 and 2 ). Femur shaft fracture was most common in preschool children (1,699 cases), followed by infants (1,139 cases), school children (793 cases), and adolescents (at least 262 fractures). The tibia shaft fracture was most common in preschool children (1163 cases), followed by 1121cases in schoolchildren, 609 cases in adolescents and 165 cases in infants. For fractures of the fibula shaft, it was most common in school children (812 cases), preschool children (718 cases), adolescents (438 cases), and infants (93 cases). Distal tibia fracture was most common in adolescents (816 cases), school children (728 cases), preschool children (409 cases), and at least 73 cases in infants. For the 734 pelvic fracture cases, the most common age group was preschool children (267 cases), followed by adolescents (218 cases), school children (157 cases), and infants (92 cases) (Table 2 ). Table 2 The epidemiology of age group according to different fractures sites Fractures sites Infants Preschool children School children Adolcent Patella 0 3 82 67 Proximal fibula 0 1 1 2 Shaft of fibula 93 718 812 438 Distal fibula 28 226 339 401 Proximal tibia 25 37 80 183 Shaft of tibia 165 1163 1121 609 Distal tibia 73 409 728 816 Proximal femur 61 215 201 228 Shaft of femur 1139 1699 793 262 Distal femur 93 169 106 78 Pelvis 92 267 157 218 Among the included 10,808 children, 9,599 underwent surgery, while 1,209 were treated with non-surgical therapy. The ratio of surgical to non-surgical treatments was 8:1. Of the 9,599 children who underwent surgery, 4,781 underwent open reduction, and 4,818 underwent closed reduction. The treatment ratio between open and closed reductions was 1:1. Cause of injury In children with lower limb and pelvic fractures, the leading cause of injury was falling over in 4629 children, followed by traffic accidents in 3434 children, falling from a height in 1115 children, other and unknown reasons in 573 children, and being struck or hit in 484 children. Regarding the common causes of injuries in the different age groups, the most common cause of lower limb and pelvic fractures among children in the infant, school child, and adolescent groups was falling over, and the most common cause of injury in the preschool children group was traffic accidents (Table 3 ). Table 3 The epidemiology of age group according to different etiologies Cause of injury Infants Preschool children School children Adolescents Falling over 780 1205 1300 1344 Falling from a height 165 413 282 255 Traffic accident 345 1553 1118 418 Being struck or hit 84 219 132 49 Other reasons 81 114 142 236 Unknown 107 216 170 80 For falling over, the adolescents had the most significant number (1344 cases), including 1039 males and 305 females, followed by the school children (1300 cases), 780 males and 520 females, and the preschool children (1205 cases), 770 males and 435 females. In the infant group, at least 780 children were injured due to falls, including 504 males and 276 females. Second, traffic accidents (3434 cases), including 2235 males and 1199 females, was the second-largest cause of injury. The Preschool children group had the most children (1553 cases), followed by the school children group (1118 cases), the adolescent group (418 cases), and the infant group with the smallest number of children with injuries due to traffic accidents (345 cases). There were 1115 cases, 739 males and 376 females of high-energy injuries from falling from a height. Among them, preschool children had the most significant number of 413 cases. There were 282 cases in the school children group and 255 in the adolescent group. Similarly, the infant group had the lowest number of children whose injuries were caused by falling from a height (165 cases). Concomitant trauma Among the 10,808 children with lower limb and pelvic fractures, 1,806 presented with concomitant trauma to other systems. Among them, concomitant respiratory trauma was the most common, with 721 cases; concomitant nervous trauma occurred in 539 cases, concomitant digestive trauma (260 cases), concomitant urinary trauma (250 cases), and concomitant circulatory trauma was observed in 36 cases (Tables 4 – 7 ). Table 4 Concomitant nervous injury and complication Parameter Patients number Scalp hematoma 212 Intracerebral hemorrhage 94 Subarachnoid hemorrhage 54 Traumatic paralysis 45 Subdural hemorrhag 39 Epidural hemorrhage 36 Cerebellar contusion injury 16 Cerebral contusion injury 13 Concussion 8 Diffuse axonal injury 7 Brain nerve injury 4 Intracranial sinus injury 3 Brain death 3 Epilepsy 2 Brainstem injury 1 Diffuse cerebellar injury 1 Table 5 Concomitant respiratory system injury and complication Parameter Patients number Pulmonary contusion 384 Traumatic pneumonia 164 Traumatic pneumothorax 78 Traumatic pleural effusion 48 Traumatic hemothorax 19 Pulmonary hemorrhage 11 Respiratory failure 6 Mediastinal emphysema 5 Traumatic pulmonary rupture 3 Traumatic asphyxia 1 Pulmonary embolism 1 Acute Respiratory Distress Syndrome (ARDS) 1 Table 6 Concomitant digestive system injury and complication Parameter Patients number Traumatic liver injury 144 Traumatic splenic injury 57 Traumatic pancreatic injury 23 Traumatic gallbladder injury 16 Traumatic small bowel injury 11 Traumatic colon injury 3 Traumatic anal injury 2 Traumatic gastric injury 2 Stress-related gastrointestinal bleeding 1 Traumatic retroperitoneal hematoma 1 Table 7 Concomitant urinary and circulatory system injury and complication Parameter Patients number Urinary system Traumatic renal injury 69 Traumatic urethral injury 53 Traumatic perineal injury 48 Traumatic genital injury 28 Traumatic bladder injury 25 Traumatic adrenal injury 14 Urinary tract infection 7 Renal hydronephrosis 5 Traumatic ureteral injury 1 Circulatory system Traumatic myocardial injury 36 Regarding the most common concomitant respiratory trauma, the top five were pulmonary contusion (384 cases), traumatic pneumonia (164 cases), pneumothorax (78 cases), pleural effusion (48 cases), and hemothorax (19 cases). The top five cases of concomitant nervous trauma were scalp hematoma (212 cases), intracerebral hemorrhage (94 cases), subarachnoid hemorrhage (54 cases), traumatic paralysis (45 cases), and subdural hemorrhage (39 cases). There were 260 cases of concomitant digestive trauma; the top five were traumatic liver (144 cases), splenic (57 cases), pancreatic (23 cases), and gallbladder (16 cases) injuries and minor bowel injuries (11 cases). There were 250 cases of concomitant urinary trauma, of which the top five were traumatic renal (69 cases), urethral (53 cases), peripheral (48 cases), genital (28 cases), and bladder (25 cases) injuries. In addition, 36 patients had concomitant circulatory trauma (Fig. 3 ). Monthly distribution of injuries in children with fractures A retrospective analysis of the months in which 10,808 children with lower limb and pelvic fractures were hospitalized showed that the peak time of admission was in autumn (August-October), with 2,955 cases, and the highest peak (1,073 cases) was in October. There were 2,861 fractures in spring (February–April); the highest number was in April (975 cases). In summer (May–July), there were 2,824 patients, and the maximum number of fractures in May was 1,053. In winter (November–January), there were 2,168 people, and the maximum number of fractures in November was 880. Geographical distribution of children with fractures Among the 10,808 children with lower limb and pelvic fractures, East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi provinces) had the most significant number of fractures, with 5,584 children. These were followed by the central and southern regions (Hunan Province, Guangxi Zhuang Autonomous Region, Guangdong Province, Hubei Province, and Henan Province) with 5,221 people, North China (Hebei Province, Shanxi Province, and Beijing City) with 845 people, the northwest region (Gansu Province, Qinghai Province, Xinjiang Uygur Autonomous Region, and Shaanxi Province) with 809 people, the southwest region (Guizhou Province, Yunnan Province) with 518 people, and the northeast region (Jilin Province, Liaoning Province) with 501 people (Table 8 ). Table 8 Distribution of injury in the region Parameter Patients number East China 5584 Central and Southern China 2551 North China 845 Northwest China 809 Southwest China 518 Northeast China 501 Discussion Currently, there are few studies on the overall pattern and prevalence of lower limb and pelvic fractures in Chinese children and adolescents and the concomitant trauma to other systems with lower limb and pelvic fractures in children due to high-energy trauma. This study found that ( 1 ) the number of males among hospitalized children with fractures of all ages was higher than that of females for lower limb and pelvic fractures in children, and the number of children in the preschool age group was the highest. ( 2 ) For lower limb and pelvic fractures in children, the most common fracture site was the femur shaft, with 2594 cases in males and 1299 cases in females. ( 3 ) The most common age group for pelvic fractures was preschool children. ( 4 ) The characteristics of common fracture sites differed in different age groups; the femur shaft was the most common lower limb fracture site in the infant (1139 sites) and preschool children groups (1669 sites). The tibial shaft was the most common lower limb fracture site in the schoolchildren (1121 sites) and adolescent groups (609 sites). ( 5 ) For children with lower limb and pelvic fractures, surgery is the primary treatment, and the ratio of surgical to non-surgical treatment is 8:1. For surgical treatment, the ratio between the open and closed reductions was 1:1. ( 6 ) For lower limb and pelvic fractures in children, the most common cause of injury was falling over. ( 7 ) Among the 10,808 patients who experienced lower limb and pelvic fractures due to concomitant trauma to other systems, concomitant respiratory trauma was the most common, with pulmonary contusion accounting for the highest proportion (53.26%). Age and Sex One study reported that 2,473 children and adolescents aged < 18 years with traumatic fractures were studied over 10 years and observed 936 lower limb fractures (37.8%). In addition, 473 of the 936 lower limb fractures (50.0%) accounted for the most significant proportion in the 12–18-year-old age group, and in all age groups, the number of males exceeded that of females ( 9 ). Similarly, an Israeli study reported that the peak number of female fractures occurred between ages 10 and 11 years, and the peak number of male fractures occurred between ages 12 and 13 years. In addition, the number of fractures in males was more significant than that in females in all age groups ( 19 ). In addition, a United States study reported that the peak incidence of fractures in children occurred between ages 10 and 14 years ( 20 ). In contrast with the current research results, we found that the most common age group for lower limb and pelvic fractures in children was the Preschool children group aged 2–5 years, and in all age groups, the number of male children was higher than that of female children. This study’s results are consistent with those of previous studies ( 18 , 21 – 23 ). Males are naturally active and curious and prefer high-risk outdoor activities. Therefore, even if male children have stronger bones, the incidence of lower limb and pelvic fractures is higher than that in female children of all ages. Therefore, monitoring and prevention efforts should be strengthened for males, particularly children aged 2–5 years. Fracture site and fracture season The tibial shaft is the most common fracture site in the lower extremity regions ( 24 – 26 ). However, a study in Saudi Arabia showed that among 217 children with lower limb fractures, 141, 47, and 50 had femoral, tibial, and pelvic fractures, respectively. ( 27 ). Studies have also reported that the femur (25.9%) is the most common site of lower limb fractures in children ( 28 ). In addition, the proportion of fractures in various parts of the lower limbs changes with increasing age, with the proportion of femoral fractures decreasing from 65.2–34.5% ( 29 , 30 ). Other epidemiological studies reported similar rates of femoral fractures in children ( 29 ). This finding is consistent with the results of the present study. The most common fracture site among children with lower limb and pelvic fractures was the femur shaft, followed by the tibia shaft. In addition, the incidence of femoral shaft fractures decreased with age, except in the infant group. The preschool children had the most significantly higher number of fractures. Children in this age group often ignore their surroundings due to their lively and active nature. They are prone to risky behaviors during play or activities due to the environment’s potentially hazardous nature. These behaviors may involve high-risk activities such as jumping, climbing, and running, which increase the risk of injury ( 31 ), especially if there is insufficient supervision and guidance. In particular, the lack of safety guidance from schools or community education results in a lack of the ability to identify and avoid potential dangers. In addition, consistent with our results, the most common season for lower limb fractures was autumn (August to October) ( 9 ). Therefore, the results of this study indicate that outdoor sports activities, short-term travels, and recreational plays are the most common occurrences in autumn. Therefore, excellent seasons and times for activity tend to increase the risk of lower limb and pelvic fracture traumas. Cause of injury Fractures in children can be caused by various injury mechanisms, such as sprains, falls from bed height or below (< 1 m), falls from stairs or slopes, blunt trauma, sports injuries, and traffic accidents ( 32 ). A Chinese study reported that the common causes of lower limb fractures in children are motor vehicle accidents (47%) and falls (26%), followed by falls from heights (15%) and injury from a hit (4.4%). In addition, motor vehicle accidents (47%) were the most common cause of injury among all age groups and children of both sexes( 33 ). Similarly, the most common cause of lower limb fractures in children was car accidents, followed by falls ( 34 ). A study conducted in the United States reported that two-thirds of injuries were caused by motor vehicle accidents and falls, with falls being more common in younger children and motor vehicle accidents in older children ( 35 ). In contrast to our research results, falling over was the leading cause of lower limb and pelvic fractures in children, followed by traffic accidents. In addition, for children in the infant, school, and adolescent groups, the most common cause of lower limb fractures was falling over, and the most common cause of injury in the preschool children group was traffic accidents. Regarding fracture patterns of the lower limbs and pelvis in children of different ages, there were differences in injury causes. Therefore, targeted preventive interventions based on the specific characteristics of each age group should be developed urgently to reduce the occurrence and related burden of lower limb and pelvic fractures in children, considering the characteristics of each age group and the exposure risks in daily activities in the design of personalized, scientific and effective prevention strategies. Pelvic fractures and Concomitant trauma A few studies have investigated the impact of pelvic fractures in children. The anatomical and biological characteristics of the pelvis in children are significantly different from those in adults. In children, the bones are more flexible and mineralized. This makes them relatively less likely to fracture when exposed to stress ( 36 ). We collected data on 734 pelvic fractures in children and adolescents. The top three fracture locations were iliac (208), pubic (151), and ischial (74) areas. In addition, studies have pointed out that the incidence of pelvic fractures is higher in older children. As children grow older, their bones become more mineralized, challenging, and fragile. However, in the present study, pelvic fractures were lower in the adolescent group than in the preschool group. This may be because increased age in older children positively impacts their risk perception and coping ability, making them more vulnerable to potential dangers. Precautions should also be taken independently to reduce the occurrence of pelvic fractures. In addition, in skeletally immature children, pelvic fractures, which usually occur after a sustained high-energy impact such as a car accident or a fall from a height, are likely to be transmitted to other parts of the body. When children present with complaints of lower limb and pelvic fracture injuries, surgeons should be aware of concomitant trauma to other systems, including the abdomen, genitourinary system, spine, or head ( 14 ). Similarly, the genitourinary system is more likely to be injured after trauma than any other area. Pelvic fracture is accompanied by hematuria, dysuria, and urinary retention ( 37 , 38 ). Children's organs, such as the kidneys, that are more important than other body parts, and the fat around the waist is underdeveloped and does not cushion injuries well ( 39 ). The incidence of urinary tract or bladder injury is 1.5–3.7% in patients with pelvic fractures ( 40 ). However, in the present study, respiratory trauma was the most common concomitant systemic trauma in patients with pelvic fractures. Therefore, in children with pelvic fractures due to high-energy trauma, a first examining physician should perform a detailed respiratory physical examination. For children with suspected pulmonary contusions or traumatic pneumothorax, comprehensive computed tomography scan and other imaging examinations should be performed to ensure a timely and accurate diagnosis of respiratory system injuries. For children with confirmed respiratory system injuries, timely and effective treatment methods such as tracheal intubation, mechanical ventilation, and chest drainage are vital to ensure adequate oxygenation and ventilation. This series of measures is crucial to prevent the progression of respiratory system complications, help slow the development of complications to the greatest extent and improve children's recovery and survival rates. Conclusion We should strengthen health and safety education for children, parents, communities, and schools based on distribution characteristics such as age, sex, and causes of injuries. Protective measures for children’s activities should also be increased. The incidence of lower limb fractures in children can be reduced and healthy growth through comprehensive intervention measures can be ensured. High-energy trauma in children resulting in pelvic fractures and concomitant multi-system injuries is challenging, and its treatment and management require interdisciplinary teamwork. Therefore, comprehensive and individualized treatment plans for pelvic fractures and multi-system accompanying injuries due to high-energy trauma in children through close cooperation should be provided among pediatric orthopedics, critical care medicine, pediatric surgery, pediatric internal medicine, and other specialties, minimizing the risk of death in children. Declarations Ethics approval and consent to participate This study was carried out in full compliance with the Declaration of Helsinki. This study has been approved by the Medical Ethics Committee of the Shenzhen Children’s Hospital (No. 202000302). All patients and their legal guardian/Parents voluntarily participated and signed the informed consent form. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests The authors declare no affiliation with or financial involvement in organizations or entities with a direct financial interest in the subject matter or materials discussed in the manuscript. Funding This study was supported by Guangdong High-level Hospital Construction Fund and Sanming Project of Medicine in Shenzhen (SZSM202011012). Author Contributions Xin Qiu, Tianfeng Zhu, Hansheng Deng, Jianlin Chen and Haoran Feng conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Xin Qiu, Guoshuang Feng, Leonardo Antonio Sechi, Gianfilippo Caggiari, Chao You and Guibing Fu designed the data collection instruments, coordinated and supervised data collection and critically reviewed the manuscript. Zilong Huang, Jiahui Li, Xinyu Wang, Shizhe Liu, Shuaiyin Wang, Zhenkun Gu, Zhengyu Wu, Qisong Yang and Gen Liu collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Acknowledgments ： The authors thank the staff members of Futang Research Centre of Pediatric Development (FRCPD) for their help and collaboration. List of investigators and members of Futang Research Centre of Pediatric development(FRCPD) Yueping Zeng, Jian Tian, Fei Song, Xin Xu — Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China; Mei Wu — Medical Record Department, Anhui Children’s Hospital, Hefei, China; Guosong Wang — Information Centre, Anhui Children’s Hospital, Hefei, China; Li Li — Medical Record Department, Dalian Children’s Hospital, Dalian, China; Hongjie Sun — Information Department, Dalian Children’s Hospital, Dalian, China; Zhenqiang Da —Medical Record Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; WenJuan Wang — Information Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; Qinghong He — Medical Record Department, Guiyang Children’s Hospital, Guiyang, China; Shaoqian Liu — Information Centre, Guiyang Children’s Hospital, Guiyang, China; Ling Dai — Information Department, Hangzhou Children’s Hospital,Hangzhou, China; Waiguang Hu — Information Centre, Hunan Children’s Hospital, Hangzhou,China; Xiaomei Chen — Medical Record Department,Inner Mongolia Children’s Hospital, Hohhot, China;Xiaoqin Wang, Jian Du — Information Department,Inner Mongolia Children’s Hospital, Hohhot, China;Chunxiang Wang — Medical Record Department,Jinan Children’s Hospital, Jinan, China; Yuanyi Qu — Information Department, Jinan Children’s Hospital, Jinan, China; Daqiao Zhu — Medical Record Department, Kunming Children’s Hospital, Kunming,China; Jian Ding — Information Department, Kunming Children’s Hospital, Kunming, China; HaibinZhou — Medical Record Department, Liaocheng Children’s Hospital, Liaocheng, China; Jinchi Shi — Information Department, Liaocheng Children’s Hospital,Liaocheng, China; Zhijun Pan — Medical Record Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Lei Yang — Information Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Tingting Zhang — Medical Record Department, Nanjing Children’s Hospital, Nanjing, China; Jin Xu — Information Department, Nanjing Children’s Hospital, Nanjing, China; Lianjun Ruan — Medical Record Department, Qinghai Children’s Hospital, Xining, China; Shu Mai —Information Department, Qinghai Children’s Hospital, Xining, China; Fengmei Ma — Department of quality control, Qinghai Children’s Hospital, Xining, China; Li Gao — Medical Record Department, Shanxi Children’s Hospital, Taiyuan, China; Hongcheng Liu — Information Centre, Shanxi Children’s Hospital, Taiyuan, China; Xirong Chen — Medical Record Department, Shenzhen Children’s Hospital, Shenzhen, China; Yuzheng Zhang — Information Department, Shenzhen Children’s Hospital, Shenzhen, China; Jun Zhou — Medical Record Department, Urumqi Children’s Hospital, Urumqi, China; ChunXiang Yan — Medical Record Department, Wuhan Children’s Hospital, Wuhan, China; Jian Fang —Information Centre, Wuhan Children’s Hospital, Wuhan, China. 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Cite Share Download PDF Status: Published Journal Publication published 13 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 11 Sep, 2024 Reviews received at journal 10 Sep, 2024 Reviewers agreed at journal 10 Sep, 2024 Reviewers agreed at journal 09 Sep, 2024 Reviews received at journal 21 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers invited by journal 21 Aug, 2024 Editor assigned by journal 21 Aug, 2024 Editor invited by journal 21 Jun, 2024 Submission checks completed at journal 19 Jun, 2024 First submitted to journal 18 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Hospital","correspondingAuthor":true,"prefix":"","firstName":"Guibing","middleName":"","lastName":"Fu","suffix":""}],"badges":[],"createdAt":"2024-06-18 05:44:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4597527/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4597527/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-77970-x","type":"published","date":"2024-11-13T15:57:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60433324,"identity":"4db871a2-342a-4fef-832f-b769ced875f6","added_by":"auto","created_at":"2024-07-16 16:58:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":624018,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThis picture show the fracture sites of the tibia and fibula in pediatric lower limb and pelvic fractures.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Specific Details of tibial fracture site.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Specific Details of fibula fracture site.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597527/v1/7c6b44ac9c3ef1df611381a5.jpg"},{"id":60433323,"identity":"c73a4e28-12a6-4b99-b488-90f20bd78a6d","added_by":"auto","created_at":"2024-07-16 16:58:32","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":870745,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThis picture show the fracture sites of the femur, patella, and pelvis in pediatric lower limb and pelvic fractures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Specific Details of femur fracture site.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. Specific Details of pelvis fracture site.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec. Specific Details of patella fracture site.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597527/v1/9534e004c32d93897246d448.jpg"},{"id":60433322,"identity":"a3f32615-a529-4f64-8ab1-c04780ed6ead","added_by":"auto","created_at":"2024-07-16 16:58:32","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1047728,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThis picture show the concomitant trauma and complications associated with pediatric lower limb and pelvic fractures\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4597527/v1/c8adf366ff7776a161bb700c.jpg"},{"id":69285698,"identity":"632de4c9-9d18-4c47-b4c3-a79a0344123f","added_by":"auto","created_at":"2024-11-18 19:27:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3402373,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4597527/v1/97532585-7506-41f9-91fa-18c68d70e611.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUnintentional childhood injuries have become a primary global public health concern, with a significant number of children and adolescents succumbing to accidental injuries worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Fractures are the most common type of unintentional injuries in children, accounting for 10\u0026ndash;25% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with an increasing incidence of childhood fractures as they grow (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In addition, among patients of various age groups with lower limb fractures, children and adolescents account for approximately 19.2% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), with potential consequences leading to higher mortality rates in children (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Childhood fracture types vary according to local climate, culture, and recreational activities, resulting in diverse causative factors for fractures in different countries or regions within a country (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Sweden reported that 19.5% of childhood fractures occurred in the lower limbs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similarly, in Switzerland, among 2716 patients (60% male), there were 2840 cases of long bone fractures, with tibia, fibula, and femur fractures accounting for approximately 20% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, trauma leading to pediatric pelvic fractures is rare, occurring only in 0.5\u0026ndash;7.0% of children (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). For immature skeletal structures in children, pelvic fractures typically occur following high-energy impacts such as traffic accidents or falling from a height. In such cases, the injuries will likely extend to other body parts. Therefore, surgeons treating pediatric pelvic fractures should be vigilant about concomitant trauma extending to other systems, including the abdomen, genitourinary system, spine, or head (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, there is currently limited research on lower limb and pelvic fracture-associated injuries in children.\u003c/p\u003e \u003cp\u003eChina has the second largest children population globally, accounting for 12.9% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Consequently, research on the overall patterns and trends of lower limb and pelvic fractures in Chinese children and adolescents is limited. We conducted a retrospective analysis of epidemiological surveys of lower limb and pelvic fractures in children from 27 tertiary pediatric hospitals in China. This study aimed to provide a scientific basis for developing targeted preventive and therapeutic measures to reduce the occurrence of lower limb and pelvic fractures in children, enhance the treatment efficiency for fractures accompanied by multi-system injuries, and improve children\u0026rsquo;s overall quality of life.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe conducted a retrospective analysis of the medical records of hospitalized children with lower limb and pelvic fractures at the FuTang Research Center for Pediatric Development (FRCPD) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) in 27 tertiary children's hospitals in China between December 1, 2015, and December 31, 2019. Using the International Statistical Classification of Diseases and Related Health Problems coding 10, we collected data on age, sex, causes of injury, fracture sites, treatment modalities, concomitant trauma to other systems, the season of hospital visits, and region, from the medical record index of pediatric inpatients with lower limb and pelvic fractures.\u003c/p\u003e \u003cp\u003eWe categorized all enrolled patients into the following age groups: Infants (\u0026lt;2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12\u0026ndash;18 years), the causes of fractures were classified based on the injury mechanism: falling over, falling from a height, traffic accidents, being struck or hit, other reasons, and unknown reasons(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe fracture sites were anatomically classified into the patella, proximal fibula, fibula shaft, distal fibula, proximal tibia, tibia shaft, distal tibia, proximal femur, femur shaft, distal femur, and pelvis (including the ilium, pubis, ischium, sacrum, and acetabulum).\u003c/p\u003e \u003cp\u003eConcomitant systemic trauma was divided into nervous, respiratory, digestive, urinary, and circulatory system traumas.\u003c/p\u003e \u003cp\u003eBased on the admission time of the pediatric patients, hospitalized individuals were categorized into one of the four seasons: Spring, Summer, Autumn, and Winter. According to the geographical regions where fractures occurred, hospitalized patients were classified into seven geographical areas: East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi), Northwest China (Gansu, Qinghai, Xinjiang Uygur Autonomous Region, and Shaanxi), North China (Hebei, Shanxi, and Beijing), Southwest China (Guizhou and Yunnan), Northeast China (Jilin and Liaoning), and Central South China (Hunan, Guangxi Zhuang Autonomous Region, Guangdong, Hubei, and Henan).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAge and sex\u003c/h2\u003e \u003cp\u003eIn total, 10,808 pediatric patients were included in this study, with 7,152 males and 3,656 females. In all age groups, the number of males exceeded that of females. The preschool children and infants had the highest and lowest incidences of fractures, respectively. Among the pediatric patients in the four age groups, the infant group had 1,562 individuals with fractures, including 965 males and 597 females. Fracture incidence gradually increased with age, with the highest occurrence in the preschool children group, accounting for 3,720 individuals (2,419 males and 1,301 females). Subsequently, the number of fractures decreased, with 3,144 individuals in the school children group, including 1,948 males and 1,196 females, and a further decline in the adolescent group, accounting for 2,382 individuals, including 1,820 males and 562 females. The sex ratio difference in fractures increased with age, where the male-to-female ratio was 4:1 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with the most significant difference in the adolescent group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of patients with 10808 fractures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumbers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1562(15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreschool children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3720(34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3144(29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2382(22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3656(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7152(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeason\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2861(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2824(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutumn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2955(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2168(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eFracture site and treatment\u003c/h2\u003e \u003cp\u003eAmong the 10,808 pediatric patients, there were 14,398 lower limb and pelvic fracture sites. The most common fracture sites were the femur shaft (3,893 cases: 2,594 males and 1,299 females). Subsequently, fractures of the tibial shaft (3,058 cases), fibular shaft (2,061 cases), distal tibia (2,026 cases), and distal fibula (994 cases) were observed. There were 734 cases of pelvic fractures, including 25 acetabular fractures, 208 iliac, 151 pubic, 74 ischial, and 55 sacral bone fractures, and 221 unknown fractures. Proximal femur fractures occurred in 705 patients, distal femur fractures in 446, proximal tibia fractures in 325, patellar fractures in 152, and proximal fibular fractures in four patients (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFemur shaft fracture was most common in preschool children (1,699 cases), followed by infants (1,139 cases), school children (793 cases), and adolescents (at least 262 fractures). The tibia shaft fracture was most common in preschool children (1163 cases), followed by 1121cases in schoolchildren, 609 cases in adolescents and 165 cases in infants. For fractures of the fibula shaft, it was most common in school children (812 cases), preschool children (718 cases), adolescents (438 cases), and infants (93 cases). Distal tibia fracture was most common in adolescents (816 cases), school children (728 cases), preschool children (409 cases), and at least 73 cases in infants. For the 734 pelvic fracture cases, the most common age group was preschool children (267 cases), followed by adolescents (218 cases), school children (157 cases), and infants (92 cases) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe epidemiology of age group according to different fractures sites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFractures sites\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreschool children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdolcent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal fibula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShaft of fibula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal fibula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShaft of tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShaft of femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the included 10,808 children, 9,599 underwent surgery, while 1,209 were treated with non-surgical therapy. The ratio of surgical to non-surgical treatments was 8:1. Of the 9,599 children who underwent surgery, 4,781 underwent open reduction, and 4,818 underwent closed reduction. The treatment ratio between open and closed reductions was 1:1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCause of injury\u003c/h2\u003e \u003cp\u003eIn children with lower limb and pelvic fractures, the leading cause of injury was falling over in 4629 children, followed by traffic accidents in 3434 children, falling from a height in 1115 children, other and unknown reasons in 573 children, and being struck or hit in 484 children. Regarding the common causes of injuries in the different age groups, the most common cause of lower limb and pelvic fractures among children in the infant, school child, and adolescent groups was falling over, and the most common cause of injury in the preschool children group was traffic accidents (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe epidemiology of age group according to different etiologies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreschool children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdolescents\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalling over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalling from a height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraffic accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeing struck or hit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor falling over, the adolescents had the most significant number (1344 cases), including 1039 males and 305 females, followed by the school children (1300 cases), 780 males and 520 females, and the preschool children (1205 cases), 770 males and 435 females. In the infant group, at least 780 children were injured due to falls, including 504 males and 276 females.\u003c/p\u003e \u003cp\u003eSecond, traffic accidents (3434 cases), including 2235 males and 1199 females, was the second-largest cause of injury. The Preschool children group had the most children (1553 cases), followed by the school children group (1118 cases), the adolescent group (418 cases), and the infant group with the smallest number of children with injuries due to traffic accidents (345 cases).\u003c/p\u003e \u003cp\u003eThere were 1115 cases, 739 males and 376 females of high-energy injuries from falling from a height. Among them, preschool children had the most significant number of 413 cases. There were 282 cases in the school children group and 255 in the adolescent group. Similarly, the infant group had the lowest number of children whose injuries were caused by falling from a height (165 cases).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eConcomitant trauma\u003c/h2\u003e \u003cp\u003eAmong the 10,808 children with lower limb and pelvic fractures, 1,806 presented with concomitant trauma to other systems. Among them, concomitant respiratory trauma was the most common, with 721 cases; concomitant nervous trauma occurred in 539 cases, concomitant digestive trauma (260 cases), concomitant urinary trauma (250 cases), and concomitant circulatory trauma was observed in 36 cases (Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConcomitant nervous injury and complication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScalp hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntracerebral hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubarachnoid hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic paralysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubdural hemorrhag\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebellar contusion injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral contusion injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse axonal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain nerve injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntracranial sinus injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpilepsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrainstem injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse cerebellar injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConcomitant respiratory system injury and complication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary contusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic pneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic pleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic hemothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediastinal emphysema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic pulmonary rupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic asphyxia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute Respiratory Distress Syndrome (ARDS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConcomitant digestive system injury and complication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic liver injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic splenic injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic pancreatic injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic gallbladder injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic small bowel injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic colon injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic anal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic gastric injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress-related gastrointestinal bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic retroperitoneal hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConcomitant urinary and circulatory system injury and complication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrinary system\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic renal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic urethral injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic perineal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic genital injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic bladder injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic adrenal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal hydronephrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic ureteral injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCirculatory system\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic myocardial injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the most common concomitant respiratory trauma, the top five were pulmonary contusion (384 cases), traumatic pneumonia (164 cases), pneumothorax (78 cases), pleural effusion (48 cases), and hemothorax (19 cases). The top five cases of concomitant nervous trauma were scalp hematoma (212 cases), intracerebral hemorrhage (94 cases), subarachnoid hemorrhage (54 cases), traumatic paralysis (45 cases), and subdural hemorrhage (39 cases). There were 260 cases of concomitant digestive trauma; the top five were traumatic liver (144 cases), splenic (57 cases), pancreatic (23 cases), and gallbladder (16 cases) injuries and minor bowel injuries (11 cases). There were 250 cases of concomitant urinary trauma, of which the top five were traumatic renal (69 cases), urethral (53 cases), peripheral (48 cases), genital (28 cases), and bladder (25 cases) injuries. In addition, 36 patients had concomitant circulatory trauma (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMonthly distribution of injuries in children with fractures\u003c/h2\u003e \u003cp\u003eA retrospective analysis of the months in which 10,808 children with lower limb and pelvic fractures were hospitalized showed that the peak time of admission was in autumn (August-October), with 2,955 cases, and the highest peak (1,073 cases) was in October. There were 2,861 fractures in spring (February\u0026ndash;April); the highest number was in April (975 cases). In summer (May\u0026ndash;July), there were 2,824 patients, and the maximum number of fractures in May was 1,053. In winter (November\u0026ndash;January), there were 2,168 people, and the maximum number of fractures in November was 880.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eGeographical distribution of children with fractures\u003c/h2\u003e \u003cp\u003eAmong the 10,808 children with lower limb and pelvic fractures, East China (Anhui, Shandong, Jiangsu, Zhejiang, Fujian, and Jiangxi provinces) had the most significant number of fractures, with 5,584 children. These were followed by the central and southern regions (Hunan Province, Guangxi Zhuang Autonomous Region, Guangdong Province, Hubei Province, and Henan Province) with 5,221 people, North China (Hebei Province, Shanxi Province, and Beijing City) with 845 people, the northwest region (Gansu Province, Qinghai Province, Xinjiang Uygur Autonomous Region, and Shaanxi Province) with 809 people, the southwest region (Guizhou Province, Yunnan Province) with 518 people, and the northeast region (Jilin Province, Liaoning Province) with 501 people (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of injury in the region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEast China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral and Southern China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthwest China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthwest China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNortheast China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, there are few studies on the overall pattern and prevalence of lower limb and pelvic fractures in Chinese children and adolescents and the concomitant trauma to other systems with lower limb and pelvic fractures in children due to high-energy trauma. This study found that (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the number of males among hospitalized children with fractures of all ages was higher than that of females for lower limb and pelvic fractures in children, and the number of children in the preschool age group was the highest. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) For lower limb and pelvic fractures in children, the most common fracture site was the femur shaft, with 2594 cases in males and 1299 cases in females. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The most common age group for pelvic fractures was preschool children. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The characteristics of common fracture sites differed in different age groups; the femur shaft was the most common lower limb fracture site in the infant (1139 sites) and preschool children groups (1669 sites). The tibial shaft was the most common lower limb fracture site in the schoolchildren (1121 sites) and adolescent groups (609 sites). (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) For children with lower limb and pelvic fractures, surgery is the primary treatment, and the ratio of surgical to non-surgical treatment is 8:1. For surgical treatment, the ratio between the open and closed reductions was 1:1. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) For lower limb and pelvic fractures in children, the most common cause of injury was falling over. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Among the 10,808 patients who experienced lower limb and pelvic fractures due to concomitant trauma to other systems, concomitant respiratory trauma was the most common, with pulmonary contusion accounting for the highest proportion (53.26%).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAge and Sex\u003c/h2\u003e \u003cp\u003eOne study reported that 2,473 children and adolescents aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years with traumatic fractures were studied over 10 years and observed 936 lower limb fractures (37.8%). In addition, 473 of the 936 lower limb fractures (50.0%) accounted for the most significant proportion in the 12\u0026ndash;18-year-old age group, and in all age groups, the number of males exceeded that of females (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, an Israeli study reported that the peak number of female fractures occurred between ages 10 and 11 years, and the peak number of male fractures occurred between ages 12 and 13 years. In addition, the number of fractures in males was more significant than that in females in all age groups (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In addition, a United States study reported that the peak incidence of fractures in children occurred between ages 10 and 14 years (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast with the current research results, we found that the most common age group for lower limb and pelvic fractures in children was the Preschool children group aged 2\u0026ndash;5 years, and in all age groups, the number of male children was higher than that of female children. This study\u0026rsquo;s results are consistent with those of previous studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Males are naturally active and curious and prefer high-risk outdoor activities. Therefore, even if male children have stronger bones, the incidence of lower limb and pelvic fractures is higher than that in female children of all ages. Therefore, monitoring and prevention efforts should be strengthened for males, particularly children aged 2\u0026ndash;5 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFracture site and fracture season\u003c/h2\u003e \u003cp\u003eThe tibial shaft is the most common fracture site in the lower extremity regions (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, a study in Saudi Arabia showed that among 217 children with lower limb fractures, 141, 47, and 50 had femoral, tibial, and pelvic fractures, respectively. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Studies have also reported that the femur (25.9%) is the most common site of lower limb fractures in children (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In addition, the proportion of fractures in various parts of the lower limbs changes with increasing age, with the proportion of femoral fractures decreasing from 65.2\u0026ndash;34.5% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Other epidemiological studies reported similar rates of femoral fractures in children (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This finding is consistent with the results of the present study. The most common fracture site among children with lower limb and pelvic fractures was the femur shaft, followed by the tibia shaft. In addition, the incidence of femoral shaft fractures decreased with age, except in the infant group. The preschool children had the most significantly higher number of fractures. Children in this age group often ignore their surroundings due to their lively and active nature. They are prone to risky behaviors during play or activities due to the environment\u0026rsquo;s potentially hazardous nature. These behaviors may involve high-risk activities such as jumping, climbing, and running, which increase the risk of injury (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), especially if there is insufficient supervision and guidance. In particular, the lack of safety guidance from schools or community education results in a lack of the ability to identify and avoid potential dangers. In addition, consistent with our results, the most common season for lower limb fractures was autumn (August to October) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Therefore, the results of this study indicate that outdoor sports activities, short-term travels, and recreational plays are the most common occurrences in autumn. Therefore, excellent seasons and times for activity tend to increase the risk of lower limb and pelvic fracture traumas.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCause of injury\u003c/h2\u003e \u003cp\u003eFractures in children can be caused by various injury mechanisms, such as sprains, falls from bed height or below (\u0026lt;\u0026thinsp;1 m), falls from stairs or slopes, blunt trauma, sports injuries, and traffic accidents (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). A Chinese study reported that the common causes of lower limb fractures in children are motor vehicle accidents (47%) and falls (26%), followed by falls from heights (15%) and injury from a hit (4.4%). In addition, motor vehicle accidents (47%) were the most common cause of injury among all age groups and children of both sexes(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Similarly, the most common cause of lower limb fractures in children was car accidents, followed by falls (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). A study conducted in the United States reported that two-thirds of injuries were caused by motor vehicle accidents and falls, with falls being more common in younger children and motor vehicle accidents in older children (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast to our research results, falling over was the leading cause of lower limb and pelvic fractures in children, followed by traffic accidents. In addition, for children in the infant, school, and adolescent groups, the most common cause of lower limb fractures was falling over, and the most common cause of injury in the preschool children group was traffic accidents. Regarding fracture patterns of the lower limbs and pelvis in children of different ages, there were differences in injury causes. Therefore, targeted preventive interventions based on the specific characteristics of each age group should be developed urgently to reduce the occurrence and related burden of lower limb and pelvic fractures in children, considering the characteristics of each age group and the exposure risks in daily activities in the design of personalized, scientific and effective prevention strategies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePelvic fractures and Concomitant trauma\u003c/h2\u003e \u003cp\u003eA few studies have investigated the impact of pelvic fractures in children. The anatomical and biological characteristics of the pelvis in children are significantly different from those in adults. In children, the bones are more flexible and mineralized. This makes them relatively less likely to fracture when exposed to stress (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). We collected data on 734 pelvic fractures in children and adolescents. The top three fracture locations were iliac (208), pubic (151), and ischial (74) areas. In addition, studies have pointed out that the incidence of pelvic fractures is higher in older children. As children grow older, their bones become more mineralized, challenging, and fragile. However, in the present study, pelvic fractures were lower in the adolescent group than in the preschool group. This may be because increased age in older children positively impacts their risk perception and coping ability, making them more vulnerable to potential dangers. Precautions should also be taken independently to reduce the occurrence of pelvic fractures.\u003c/p\u003e \u003cp\u003eIn addition, in skeletally immature children, pelvic fractures, which usually occur after a sustained high-energy impact such as a car accident or a fall from a height, are likely to be transmitted to other parts of the body. When children present with complaints of lower limb and pelvic fracture injuries, surgeons should be aware of concomitant trauma to other systems, including the abdomen, genitourinary system, spine, or head (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Similarly, the genitourinary system is more likely to be injured after trauma than any other area. Pelvic fracture is accompanied by hematuria, dysuria, and urinary retention (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Children's organs, such as the kidneys, that are more important than other body parts, and the fat around the waist is underdeveloped and does not cushion injuries well (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The incidence of urinary tract or bladder injury is 1.5\u0026ndash;3.7% in patients with pelvic fractures (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, in the present study, respiratory trauma was the most common concomitant systemic trauma in patients with pelvic fractures. Therefore, in children with pelvic fractures due to high-energy trauma, a first examining physician should perform a detailed respiratory physical examination. For children with suspected pulmonary contusions or traumatic pneumothorax, comprehensive computed tomography scan and other imaging examinations should be performed to ensure a timely and accurate diagnosis of respiratory system injuries. For children with confirmed respiratory system injuries, timely and effective treatment methods such as tracheal intubation, mechanical ventilation, and chest drainage are vital to ensure adequate oxygenation and ventilation. This series of measures is crucial to prevent the progression of respiratory system complications, help slow the development of complications to the greatest extent and improve children's recovery and survival rates.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe should strengthen health and safety education for children, parents, communities, and schools based on distribution characteristics such as age, sex, and causes of injuries. Protective measures for children\u0026rsquo;s activities should also be increased. The incidence of lower limb fractures in children can be reduced and healthy growth through comprehensive intervention measures can be ensured.\u003c/p\u003e \u003cp\u003eHigh-energy trauma in children resulting in pelvic fractures and concomitant multi-system injuries is challenging, and its treatment and management require interdisciplinary teamwork. Therefore, comprehensive and individualized treatment plans for pelvic fractures and multi-system accompanying injuries due to high-energy trauma in children through close cooperation should be provided among pediatric orthopedics, critical care medicine, pediatric surgery, pediatric internal medicine, and other specialties, minimizing the risk of death in children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in full compliance with the Declaration of Helsinki. This study has been approved by the Medical Ethics Committee of the Shenzhen Children\u0026rsquo;s Hospital (No. 202000302). All patients and their legal guardian/Parents voluntarily participated and signed the informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no affiliation with or financial involvement in organizations or entities with a direct financial interest in the subject matter or materials discussed in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Guangdong High-level Hospital Construction Fund and Sanming Project of Medicine in Shenzhen (SZSM202011012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXin Qiu, Tianfeng Zhu, Hansheng Deng, Jianlin Chen and Haoran Feng conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Xin Qiu, Guoshuang Feng, Leonardo Antonio Sechi, Gianfilippo Caggiari, Chao You and Guibing Fu designed the data collection instruments, coordinated and supervised data collection and critically reviewed the manuscript. Zilong Huang, Jiahui Li, Xinyu Wang, Shizhe Liu, Shuaiyin Wang, Zhenkun Gu, Zhengyu Wu, Qisong Yang and Gen Liu collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff members of Futang Research Centre of Pediatric Development (FRCPD) for their help\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand collaboration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eList of investigators and members of Futang Research Centre of Pediatric development(FRCPD)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYueping Zeng, Jian Tian, Fei Song, Xin Xu \u0026mdash; Beijing Children\u0026rsquo;s Hospital, Capital Medical University, National Centre for Children\u0026rsquo;s Health, Beijing, China; Mei Wu \u0026mdash; Medical Record Department, Anhui Children\u0026rsquo;s Hospital, Hefei, China; Guosong Wang \u0026mdash; Information Centre, Anhui Children\u0026rsquo;s Hospital, Hefei, China; Li Li \u0026mdash; Medical Record Department, Dalian Children\u0026rsquo;s Hospital, Dalian, China; Hongjie Sun \u0026mdash; Information Department, Dalian Children\u0026rsquo;s Hospital, Dalian, China; Zhenqiang Da \u0026mdash;Medical Record Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; WenJuan Wang \u0026mdash; Information Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China; Qinghong He \u0026mdash; Medical Record Department, Guiyang Children\u0026rsquo;s Hospital, Guiyang, China; Shaoqian Liu \u0026mdash; Information Centre, Guiyang Children\u0026rsquo;s Hospital, Guiyang, China; Ling Dai \u0026mdash; Information Department, Hangzhou Children\u0026rsquo;s Hospital,Hangzhou, China; Waiguang Hu \u0026mdash; Information Centre, Hunan Children\u0026rsquo;s Hospital, Hangzhou,China; Xiaomei Chen \u0026mdash; Medical Record Department,Inner Mongolia Children\u0026rsquo;s Hospital, Hohhot, China;Xiaoqin Wang, Jian Du \u0026mdash; Information Department,Inner Mongolia Children\u0026rsquo;s Hospital, Hohhot, China;Chunxiang Wang \u0026mdash; Medical Record Department,Jinan Children\u0026rsquo;s Hospital, Jinan, China; Yuanyi Qu \u0026mdash; Information Department, Jinan Children\u0026rsquo;s Hospital, Jinan, China; Daqiao Zhu \u0026mdash; Medical Record Department, Kunming Children\u0026rsquo;s Hospital, Kunming,China; Jian Ding \u0026mdash; Information Department, Kunming Children\u0026rsquo;s Hospital, Kunming, China; HaibinZhou \u0026mdash; Medical Record Department, Liaocheng Children\u0026rsquo;s Hospital, Liaocheng, China; Jinchi Shi \u0026mdash; Information Department, Liaocheng Children\u0026rsquo;s Hospital,Liaocheng, China; Zhijun Pan \u0026mdash; Medical Record Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Lei Yang \u0026mdash; Information Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China; Tingting Zhang \u0026mdash; Medical Record Department, Nanjing Children\u0026rsquo;s Hospital, Nanjing, China; Jin Xu \u0026mdash; Information Department, Nanjing Children\u0026rsquo;s Hospital, Nanjing, China; Lianjun Ruan \u0026mdash; Medical Record Department, Qinghai Children\u0026rsquo;s Hospital, Xining, China; Shu Mai \u0026mdash;Information Department, Qinghai Children\u0026rsquo;s Hospital, Xining, China; Fengmei Ma \u0026mdash; Department of quality control, Qinghai Children\u0026rsquo;s Hospital, Xining, China; Li Gao \u0026mdash; Medical Record Department, Shanxi Children\u0026rsquo;s Hospital, Taiyuan, China; Hongcheng Liu \u0026mdash; Information Centre, Shanxi Children\u0026rsquo;s Hospital, Taiyuan, China; Xirong Chen \u0026mdash; Medical Record Department, Shenzhen Children\u0026rsquo;s Hospital, Shenzhen, China; Yuzheng Zhang \u0026mdash; Information Department, Shenzhen Children\u0026rsquo;s Hospital, Shenzhen, China; Jun Zhou \u0026mdash; Medical Record Department, Urumqi Children\u0026rsquo;s Hospital, Urumqi, China; ChunXiang Yan \u0026mdash; Medical Record Department, Wuhan Children\u0026rsquo;s Hospital, Wuhan, China; Jian Fang \u0026mdash;Information Centre, Wuhan Children\u0026rsquo;s Hospital, Wuhan, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLao Z, Gifford M, Dalal K(2012) Economic cost of childhood unintentional injuries. 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Cureus.12:e6550.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeideken J, Svensson T, Blomqvist P(2011) Incidence and trends in femur shaft fractures in Swedish children between 1987 and 2005. Journal of pediatric orthopedics.31:512\u0026ndash;519.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalbot C, Davis N, Majid I(2018) Fractures of the femoral shaft in children: national epidemiology and treatment trends in England following activation of major trauma networks. The bone \u0026amp; joint journal.100-b:109\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRokaya PK, Karki DB, Rawal M(2020) Epidemiology of Femur Fractures in Children: A Descriptive Cross Sectional Study Based on a Rural Population of Nepal. JNMA; journal of the Nepal Medical Association.58:574\u0026ndash;579.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng H, Zhao Z, Xiong Z(2023) Clinical characteristics of 1124 children with epiphyseal fractures. BMC musculoskeletal disorders.24:598.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmansouf AS, Alkhanbashi OK, Alsumairi S(2022) The Prevalence of Pediatric Lower Limb Fractures Following Motor Vehicle Accidents at King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia. Cureus.14:e28724.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper C, Dennison EM, Leufkens HG(2004) Epidemiology of childhood fractures in Britain: a study using the general practice research database. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research.19:1976\u0026ndash;1981.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoder RT, O'Donnell PW, Feinberg JR(2006) Epidemiology and mechanisms of femur fractures in children. Journal of pediatric orthopedics.26:561\u0026ndash;566.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurgut A, Kalenderer O, Gunaydin B(2015) Demographic Characteristics of Paediatric Pelvic Fractures: 10-Years' Experience of Single Paediatric Orthopaedics Clinic. The Eurasian journal of medicine.47:130\u0026ndash;134.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarman GJ, Kaplan GW, Lerman SL(2002) Lower genitourinary injury and pelvic fractures in pediatric patients. Urology.59:123\u0026ndash;126; discussion 126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagedorn JC, Voelzke BB(2015) Pelvic-fracture urethral injury in children. Arab journal of urology.13:37\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNerli RB, Ghagane SC, Musale A(2019) High grade renal trauma in a child with rupture bladder and fracture pelvic bones. Urology case reports.24:100850.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker A, Yaslowitz O, Dubose J(2020) Is computed tomography cystography indicated in children with pelvic fractures? Chinese journal of traumatology\u0026thinsp;=\u0026thinsp;Zhonghua chuang shang za zhi.23:181\u0026ndash;184.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"children, injury, lower limb, pelvic fracture, concomitant trauma","lastPublishedDoi":"10.21203/rs.3.rs-4597527/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4597527/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in Chinese children to provide a theoretical basis for reducing the incidence of such fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (＜2 years), Preschool children (2-5years), School children (6-11years), and Adolescents (12-18 years).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study included 10,808 pediatric patients (7,152 males, 3,656 females). The proportion of preschool children of lower limb and pelvic fractures is the highest. Of the total patients, 14, 398 had lower limb and pelvic fracture sites. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9,599 underwent surgery, while 1,209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Concomitant trauma to other systems, in 1,806 cases, had respiratory trauma as the most common; the top three conditions were pulmonary contusions, traumatic pneumonia, and pneumothorax. Concomitant nervous system trauma had scalp hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage as the top three conditions. Concomitant digestive trauma had traumatic liver, splenic, and pancreatic injuries as the top three conditions. Concomitant urinary trauma had traumatic renal, urethral, and perineal injuries as the top three conditions. Concomitant circulatory trauma was in 36 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe epidemiological characteristics of lower-limb and pelvic fractures in children provide valuable information. Implementing appropriate and effective preventive measures is crucial for preventing the occurrence of lower limb and pelvic fractures in children. The treatment and management of pelvic fractures and the associated multi-system injuries resulting from high-energy trauma in children require interdisciplinary teamwork to minimize the risk of mortality in the affected children.\u003c/p\u003e","manuscriptTitle":"Multicenter epidemiological survey and analysis of related factors in 10,808 hospitalized children with lower limb and pelvic fractures in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 16:58:27","doi":"10.21203/rs.3.rs-4597527/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-11T05:36:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-10T12:28:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42376666776809993527774414675965622538","date":"2024-09-10T06:46:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4927993369441206184745720437086151990","date":"2024-09-09T17:15:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-21T16:37:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330022931559297366144888227403745657223","date":"2024-08-21T16:26:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-21T15:22:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-21T15:10:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-21T15:50:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T07:08:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-18T05:41:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"23fb11db-7abf-442c-912c-2b615ff91374","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":34092512,"name":"Health sciences/Health care/Disease prevention"},{"id":34092513,"name":"Health sciences/Health care/Paediatrics"},{"id":34092514,"name":"Health sciences/Health care/Patient education"},{"id":34092515,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2024-11-18T19:22:08+00:00","versionOfRecord":{"articleIdentity":"rs-4597527","link":"https://doi.org/10.1038/s41598-024-77970-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-11-13 15:57:45","publishedOnDateReadable":"November 13th, 2024"},"versionCreatedAt":"2024-07-16 16:58:27","video":"","vorDoi":"10.1038/s41598-024-77970-x","vorDoiUrl":"https://doi.org/10.1038/s41598-024-77970-x","workflowStages":[]},"version":"v1","identity":"rs-4597527","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4597527","identity":"rs-4597527","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}