Traumatic injury is the leading cause of death in children and adolescents, accounting for 20,000 deaths per year in the United States.1 Although most musculoskeletal injuries are not life threatening, they do account for approximately 10% to 25% of injuries in this age group.2

The pediatric musculoskeletal system is different from that of an adult, and, therefore, the assessment, treatment, and outcome of injuries is different. Pediatric bone is more elastic, and with a capacity for growth, there exists superior remodeling capability. Because of this, many fractures that require surgical treatment in adults may be treated nonoperatively in children. On the other hand, injury to the growing child can result in growth deformity that can lead to long-term morbidity and the need for reconstructive treatments. This section subdivides pediatric musculoskeletal trauma into six sections: upper extremity, lower extremity, hip and pelvis, spine and trunk, birth trauma, and nonaccidental trauma (child abuse). (Reference Table 7C.4 PDF CSV)

Healthcare Utilization

Trauma resulting in musculoskeletal injury was diagnosed in 11.8 million children and adolescent healthcare visits in 2013, of which 79% (9.3 million) had a primary diagnosis of musculoskeletal injury. Only a small number were serious enough to require hospitalization. Among any trauma musculoskeletal injury diagnoses, 215,200 children and adolescents were hospitalized, with 65,600 having a primary diagnosis of a musculoskeletal injury. (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Males had higher injury rates with hospitalization than females for both any diagnoses (60% of injuries) and as a primary diagnosis (67% of injuries). Hospitalization for musculoskeletal injuries were highest among adolescents age 14 years and older. Neonates under the age of one year had a high rate of musculoskeletal injury for any diagnosis with hospitalization, primarily due to a diagnosis of birth trauma (99%), but a much lower rate of hospitalization with a primary trauma diagnosis (0.5% of musculoskeletal diagnoses in this age bracket).

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Musculoskeletal injury as a primary diagnosis accounted for 13% of hospitalizations for any musculoskeletal condition diagnosis, and 1.0% of hospitalizations for any healthcare reasons for children and adolescents age 20 years and younger. For all but the youngest age, which is skewed by birth trauma, primary diagnosis of trauma accounted for 13.5% to 21.9% of all hospitalization for any musculoskeletal diagnoses. (Reference Table 7C.4 PDF CSV)

Trauma to the upper extremity account for half (50%) of all trauma healthcare visits by children and adolescents. This was followed by lower extremity trauma (38%). Spine and trunk injuries were 8%, with hip and pelvis injuries at 2%. A diagnosis of birth trauma was less than 1% of all healthcare visits but accounted for more than half (53%) of hospital discharges for musculoskeletal trauma diagnoses. Child abuse was reported in 1% of all healthcare visits for trauma. (Reference Table 7C.1.1 PDF CSV)

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Hospital Charges

Total charges averaged $37,100 for a mean 4.2-day stay when children and adolescents were hospitalized with a diagnosis of musculoskeletal injury along with other medical conditions. With a primary diagnosis of musculoskeletal injury, the stay was shorter (3.1 days), but mean charges were higher at $46,300, likely due to the high number of birth trauma cases. Mean charges were highest for older adolescents (18 to 20 years) followed by neonates. Total hospital charges for all primary musculoskeletal injury discharges in 2013 were $3.04 billion. (Reference Table 7C.4 PDF CSV)

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• 1. Depass K. Principles of trauma management in the pediatric patient. In: Abel M, ed. Orthopaedic Knowledge Update Pediatrics. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2006:249-258.
• 2. Price CT. Management of fractures. In: Morrissy RT WS, ed: Lovell and Winter's Pediatric Orthopaedics, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:1429-1526.