Mehanizam nastanka prijeloma nadlaktične kosti zagrebačke djece

Anko Antabak, Tomislav Vlahek, Dino Papeš, Tomislav Đapić, Krešimir Bulić, Tomislav Luetić

Prijelomi humerusa vrlo su česti. Većinom zahtijevaju bolničko liječenje, prate ih komplikacije i loši ishodi. Smanjenje pojavnosti prevencijom moguće je poznavanjem mehanizama nastanka prijeloma. Mehanizam nastanka uvjetovan je tjelesnim aktivnostima, životnom dobi i socijalnim okruženjem. U radu se analiziraju uzroci, aktivnosti i mjesta nastanka prijeloma humerusa u zagrebačke djece. Od 2015. do 2019. godine u KBC-u Zagreb zbog prijeloma nadlaktične kosti liječeno je 301 dijete, a u radu je analizirano 243 djece. Bilo je 143 dječaka (58,8%) i 100 djevojčica (41,2%). Prosječna starost bila je 7,5 godina, dječaka 7,9, a djevojčica 7,0 godina. Najviše djece, njih 147 (60,5%) bilo je u dobi od 5 do 9 godina. Češće je lomljena lijeva ruka (62%). Od 243 djece, njih 22 (9%) zadobilo je prijelom gornjeg, petero (2%) srednjeg i 216 (88%) donjeg dijela nadlaktične kosti. Bolnički je liječeno 223 (91,8%) djece s prijelomom humerusa. Druge teške ozljede imalo je 29 (12%) djece (6% ozljeda ulnarnog i po 3% medinusa i radijalnog živca). Uzrok prijeloma u 224 (92,2%) djece bio je pad, prometne nesreće u 5 (2,1%), a u 3 (1,2%) djece prijelom je nastao zbog direktnog udarca. Od svih prijeloma padom u razini, njih 22,4% su padovi s bicikla i 13% u igri nogometa. Kod padova s bicikla najčešća su djeca dobne skupine 5–9 godina (60%). Kod padova s male visine najčešći su pad s ljuljačke, s tobogana i trampolina (60%). S tobogana i trampolina padaju djeca predškolske dobi, a s ljuljačke u svim dobnim skupinama. Kod kuće nastaje četvrtina svih prijeloma (26,7%), na rekreacijskim terenima 28,8%, u školi 14,4%, a u prometu 14%. U zagrebačke djece najčešći mehanizmi ozljede su pad u istoj razini (kod vožnje bicikla i u igri nogometa) te padovi s male visine (trampolin, tobogan, ljuljačka).

Humeral fractures in children are very common. In most cases hospital treatment is necessary, with complications and poor outcome sometimes occurring. To reduce the incidence of humeral fractures, it is necessary to know the mechanisms of injury and circumstances in which they occur. The aim of this paper is to analyze activities and locations related to humeral fracture occurrences. The paper analyzed 243 children treated at the University Hospital Center Zagreb for fractures of the upper arm in the period from 2015 to 2019. There were 143 (58.8%) boys and 100 (41.2%) girls. Mean age was 7.5 years (boys 7.9, girls seven years). Most children, 147 (60.5%) of them, were between ages five and nine. Left-sided fractures were more common (62%). Of 243 humeral fractures, 22 (9%) were proximal fractures, five (2%) were shaft fractures, and 216 (88%) were located in the distal humerus. Hospitalization was required in 223 patients (91.8%). Associated nerve injuries were present in 29 (12%) patients (ulnar nerve 6%, median nerve 3%, radial nerve 3%). The fractures were caused by falling in 224 patients (92.2%), traffic accident in five patients (2.1%), and direct blow in three patients (1.2%). Of same level falls, 22.4% were falls of bicycle and 13% occurred while playing football. Falls of bicycle were most common in children between ages five and nine (60%). Falls from height mostly occur from swing, slide and rampoline (60%), with falls from slide and trampoline being more common in pre-school children, and falls from swing occurring in all age groups. Injuries occurred at home in 26.7% of patients, on sports/recreation grounds in 28.8%, at school in 14.4%, and in traffic in 14% of children. The most common causes of injury were same level falls (from bicycle and during football), and falls from height (swing, slide, and trampoline).