Global Burden of Pediatric Orthopaedic Fractures: An Epidemiological Analysis From 1990 to 2021 Publisher Pubmed



Hoveidaei AH ; Mosalamiaghili S ; Hosseiniasl SH ; Taghavi SP ; Salmannezhad A ; Adolf J ; Tabaie S
Source: Archives of Orthopaedic and Trauma Surgery Published:2026

Abstract

Background: Pediatric fractures are a major public health concern, noticeably impacting child morbidity. A comprehensive global analysis of incidence, disability, and socioeconomic factors has been limited. Materials and methods: This epidemiological analysis used Global Burden of Disease (GBD) 2021 data (1990–2021) to evaluate the incidence of orthopaedic fractures and years lived with disability (YLDs) in children aged 0–19 years across 204 countries. We reported trends in absolute numbers, rates per 100,000 pediatric population, and calculated average annual percent changes (AAPCs) via linear regression. The relationships of incidence with SDI and YLD with SDI were assessed using Locally Estimated Scatterplot Smoothing (LOESS) regression. In addition, the impact of COVID-19 was assessed by comparing the periods 2017–2019 and 2019–2021. Results: Global pediatric fracture incidence and YLD rates per 100,000 pediatric population significantly declined (1990–2021; AAPC: − 1.25% and − 1.53%; p < 0.001). During the COVID-19 pandemic (2019–2021), incidence rate decline slowed (– 0.08%) compared to the pre-pandemic period (− 1.615), with falls notably increasing (1.11%). In 2021, falls (51.66%), mechanical forces (15.80%), and road injuries (8.24%) were primary causes of fractures. Patella, tibia/fibula, or ankle fractures was the most common group of fractures, peaking in 15–19-year-olds. Incidence and YLD rates negatively correlated with SDI, peaking around 0.75. Conclusion: Global pediatric fracture rates declined by 1.25% annually from 1990 to 2021, with falls, mechanical forces, and road injuries as main causes. The COVID-19 pandemic increased fall-related fractures, highlighting future lockdown risks. Higher fracture rates were seen in low- and mid-SDI regions, underscoring the need for targeted prevention. Clinicians should allocate resources based on injury patterns, while policymakers must focus on prevention and improving care access in high-burden areas. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.