Clavicular fractures in children

Klavikula je jedina duga cjevasta kost u tijelu položena horizontalno i predstavlja pričvrsnicu ramenog obruča za sternum. Kao takva, podložna je silama kompresije prenesenima s ruke i ramena i sili direktnog udarca, te je jedna od kostiju koje se u djece najčešće lome. Dijagnostički postupci koje koristimo su fizikalni pregled i rendgensko snimanje. Prijelom medijalne trećine je teško vidljiv na uobičajenom rendgenogramu, pa su potrebne posebne projekcije, ponekad čak i kompjuterizirana tomografija. Dječji organizam je osjetljiviji na zračenje od odraslog, te se količina zračenja mora svesti na potrebni minimum. Dječja klavikula, u usporedbi s odraslom, ima puno veću sposobnost cijeljenja, te se u većini slučajeva može liječiti konzervativno. Najčešći su prijelomi srednje trećine. Prijelomi lateralne i medijalne trećine su zapravo odvajanja kompakte od periosta, iz kojeg se može regenerirati cijela prelomljena trećina. Prijelomi se konzervativno liječe postavljanjem imobilizacije osmicom ili Desault-ovim zavojem. Uvijek se operativno liječe prijelomi s pridruženom ozljedom brahijalne arterije ili vene, brahijalnog pleksusa ili apeksa pleure, prijelomi s rotacijom ulomka za 90°, sa pseudodislokacijom akromioklavikularnog zgloba. Nakon otvorene repozicije, ulomci se fiksiraju Kirschnerovom žicom ili pločicom i vijcima. Iz baze podataka Kliničkog bolničkog centra Rebro napravljena je statistika prijeloma klavikule u 128-ero djece, s usredotočenošću na aktivnost koju su djeca obavljala tijekom zadobivanja prijeloma i mjestu na kojem se ta ozljeda dogodila. Djeca su najviše ozljeđivana kod kuće, zatim na ulici ili cesti, pa na rekreacijskom mjestu, a najmanje u školi ili vrtiću. Ambulantno je liječeno 106 (82.8%) djece i prosječno su rendgenski snimani 1,5 puta kroz period od prosječno 2,3 tjedna. Operativno liječeni pacijenti su pored intraoperativne dijaskopije prosječno snimani konvencionalnom radiografijom 3,2 puta.Clavicle is the only long hollow bone positioned horizontally and represents the attachment of the shoulder girdle to the sternum. As so, it is submissive to the compression forces transmitted from the hand and shoulder and to direct hit forces, and is one of the most frequent fractured bones in children. Diagnostic procedures used for those fractures are physical examination and x-ray. Medial third fracture is hardly visible on the usual x-ray, therefore additional projections are needed, sometimes even computed tomography. A child`s organism is more susceptible to radiation than the grown up`s, and the radiation quantity must be brought to a minimum. Children`s clavicle, compared to the adult`s, has a lot bigger healing potential, and can be treated conservatively in most cases. The most frequent are the mid-third fractures. Lateral and medial third fractures are actually separation of compact bone from the periost, from which the whole fractured third can be regenerated. Conservative treatment includes the figure of eight and Desault bandage. Operative treatment is preserved for the fractures with associated injury of brachial arthery or vein, brachial plexus or pleural apex, fragment rotation by 90°, with acromioclavicular pseudodislcation. Open reposition is fixated with Kirschner wire or a plate. Clavicle fractures statistics for 128 children are made from Klinički bolnički centar Rebro database, with focus on the activity children were practicing when the injury occured and on the site at which the injury happened. The most frequent site of injury was at home, then the road and street, then the recreational place, and the least at school or in kindergarten. Of all children 106 (82.8%) had ambulant treatment and were filmed by x-ray 1,5 times in average, during an average period of 2,3 weeks. The children who received operative treatment beside intraoperative diascopy were filmed by x-ray 3,2 times in average

Clavicular fractures in children

Klavikula je jedina duga cjevasta kost u tijelu položena horizontalno i predstavlja pričvrsnicu ramenog obruča za sternum. Kao takva, podložna je silama kompresije prenesenima s ruke i ramena i sili direktnog udarca, te je jedna od kostiju koje se u djece najčešće lome. Dijagnostički postupci koje koristimo su fizikalni pregled i rendgensko snimanje. Prijelom medijalne trećine je teško vidljiv na uobičajenom rendgenogramu, pa su potrebne posebne projekcije, ponekad čak i kompjuterizirana tomografija. Dječji organizam je osjetljiviji na zračenje od odraslog, te se količina zračenja mora svesti na potrebni minimum. Dječja klavikula, u usporedbi s odraslom, ima puno veću sposobnost cijeljenja, te se u većini slučajeva može liječiti konzervativno. Najčešći su prijelomi srednje trećine. Prijelomi lateralne i medijalne trećine su zapravo odvajanja kompakte od periosta, iz kojeg se može regenerirati cijela prelomljena trećina. Prijelomi se konzervativno liječe postavljanjem imobilizacije osmicom ili Desault-ovim zavojem. Uvijek se operativno liječe prijelomi s pridruženom ozljedom brahijalne arterije ili vene, brahijalnog pleksusa ili apeksa pleure, prijelomi s rotacijom ulomka za 90°, sa pseudodislokacijom akromioklavikularnog zgloba. Nakon otvorene repozicije, ulomci se fiksiraju Kirschnerovom žicom ili pločicom i vijcima. Iz baze podataka Kliničkog bolničkog centra Rebro napravljena je statistika prijeloma klavikule u 128-ero djece, s usredotočenošću na aktivnost koju su djeca obavljala tijekom zadobivanja prijeloma i mjestu na kojem se ta ozljeda dogodila. Djeca su najviše ozljeđivana kod kuće, zatim na ulici ili cesti, pa na rekreacijskom mjestu, a najmanje u školi ili vrtiću. Ambulantno je liječeno 106 (82.8%) djece i prosječno su rendgenski snimani 1,5 puta kroz period od prosječno 2,3 tjedna. Operativno liječeni pacijenti su pored intraoperativne dijaskopije prosječno snimani konvencionalnom radiografijom 3,2 puta.Clavicle is the only long hollow bone positioned horizontally and represents the attachment of the shoulder girdle to the sternum. As so, it is submissive to the compression forces transmitted from the hand and shoulder and to direct hit forces, and is one of the most frequent fractured bones in children. Diagnostic procedures used for those fractures are physical examination and x-ray. Medial third fracture is hardly visible on the usual x-ray, therefore additional projections are needed, sometimes even computed tomography. A child`s organism is more susceptible to radiation than the grown up`s, and the radiation quantity must be brought to a minimum. Children`s clavicle, compared to the adult`s, has a lot bigger healing potential, and can be treated conservatively in most cases. The most frequent are the mid-third fractures. Lateral and medial third fractures are actually separation of compact bone from the periost, from which the whole fractured third can be regenerated. Conservative treatment includes the figure of eight and Desault bandage. Operative treatment is preserved for the fractures with associated injury of brachial arthery or vein, brachial plexus or pleural apex, fragment rotation by 90°, with acromioclavicular pseudodislcation. Open reposition is fixated with Kirschner wire or a plate. Clavicle fractures statistics for 128 children are made from Klinički bolnički centar Rebro database, with focus on the activity children were practicing when the injury occured and on the site at which the injury happened. The most frequent site of injury was at home, then the road and street, then the recreational place, and the least at school or in kindergarten. Of all children 106 (82.8%) had ambulant treatment and were filmed by x-ray 1,5 times in average, during an average period of 2,3 weeks. The children who received operative treatment beside intraoperative diascopy were filmed by x-ray 3,2 times in average

RADIUS FRACTURES IN CHILDREN – CAUSES AND MECHANISMS OF INJURY

Izoliran ili zajedno s ulnom, prijelom palčane kosti jedan je od najčešćih prijeloma dječje dobi. Pretežiti mehanizam nastanka ove ozljede jest pad na ispruženu ruku. Visoka pojavnost prijeloma opravdava propitivanje o mogućoj prevenciji nastanka. Preventivna postupanja moguća su jedino uz poznavanje uzroka i okolnosti nastanka prijeloma. Cilj je ovog rada analizirati okolnosti nastanka i kritična mjesta nastanka prijeloma palčane kosti po dobnim skupinama. U radu je analizirano 201 dijete liječeno u KBC-u Zagreb s prijelomom palčane kosti, u periodu od 2011. do 2013. U studiji je analizirano 85 djevojčica (42,3%) i 116 dječaka (57,7%). Prosječna dob djece iznosila je 9,6 godina. Najčešće je prijelom u distalnom dijelu (79,1%) palčane kosti. Mjesta gdje su djeca stradala bila su: park, kamp i plaža (24,9% djece), igralište, klizalište i bazeni (23,9%), škola, vrtić ili jaslice (20,9%), kod kuće i oko kuće (17,9%), na ulici (11,4%) te u trgovini ili hotelu (0,9%). Dječaci stradavaju najviše na igralištima, klizanju i na bazenima (37,1% dječaka), dok djevojčice najviše stradavaju u parkovima, kampovima i na plažama (42,4% djevojčica). Način nastanka ozljede uglavnom je pad (49,3%) koji je najčešće nastao klizanjem i koturaljkanjem (rolanjem) (32,3% svih padova). U 20,4% djece uzrok ozljede su guranje i udarac. Najmanji postotak (9,5%) djece ozlijeđen je u prometu i to vozeći bicikl. Sportske su aktivnosti uzrok nastanka ozljede u 53,7% slučajeva. One su najvažniji uzrok nastanka ozljede palčane kosti u dječjoj populaciji i padovi u toku sporta glavni su mehanizam nastanka ozljede. Dječaci najviše stradavaju u dobi od 12 godina, a djevojčice u dobi od 10 godina pa su to dobne skupine u kojima je potrebno najviše djelovati. Preventivno djelovanje potrebno je usmjeriti na ozljede nastale u parkovima, školi i sportskim aktivnostima.Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011–2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the injury was caused by pushing and hitting. The smallest percentage (9.5%) of children were injured in traffic accidents while riding a bike (only one child was hit by a car). Sport related activities caused injuries in 53.7% of the cases. Sport activities are the most important cause of the radial fractures in the pediatric population and falls during sports are the main mechanism of injury. The peak incidence is at 12 years for boys and at 10 years for girls, so intervention and/or prevention should be aimed at the age groups. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities

Prijelomi nadlaktične kosti u djece – okolnosti i uzroci nastanka [Radius fractures in children - causes and mechanisms of injury]

Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011-2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the injury was caused by pushing and hitting. The smallest percentage (9.5%) of children were injured in traffic accidents while riding a bike (only one child was hit by a car). Sport related activities caused injuries in 53.7% of the cases. Sport activities are the most important cause of the radial fractures in the pediatric population and falls during sports are the main mechanism of injury. The peak incidence is at 12 years for boys and at 10 years for girls, so intervention and/or prevention should be aimed at the age groups. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities

Prijelom palčane kosti u djece – okolnosti i uzroci nastanka [Radius fractures in children – causes and mechanisms of injury]

Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011–2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the injury was caused by pushing and hitting. The smallest percentage (9.5%) of children were injured in traffic accidents while riding a bike (only one child was hit by a car). Sport related activities caused injuries in 53.7% of the cases. Sport activities are the most important cause of the radial fractures in the pediatric population and falls during sports are the main mechanism of injury. The peak incidence is at 12 years for boys and at 10 years for girls, so intervention and/or prevention should be aimed at the age groups. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities

RADIUS FRACTURES IN CHILDREN – CAUSES AND MECHANISMS OF INJURY

Izoliran ili zajedno s ulnom, prijelom palčane kosti jedan je od najčešćih prijeloma dječje dobi. Pretežiti mehanizam nastanka ove ozljede jest pad na ispruženu ruku. Visoka pojavnost prijeloma opravdava propitivanje o mogućoj prevenciji nastanka. Preventivna postupanja moguća su jedino uz poznavanje uzroka i okolnosti nastanka prijeloma. Cilj je ovog rada analizirati okolnosti nastanka i kritična mjesta nastanka prijeloma palčane kosti po dobnim skupinama. U radu je analizirano 201 dijete liječeno u KBC-u Zagreb s prijelomom palčane kosti, u periodu od 2011. do 2013. U studiji je analizirano 85 djevojčica (42,3%) i 116 dječaka (57,7%). Prosječna dob djece iznosila je 9,6 godina. Najčešće je prijelom u distalnom dijelu (79,1%) palčane kosti. Mjesta gdje su djeca stradala bila su: park, kamp i plaža (24,9% djece), igralište, klizalište i bazeni (23,9%), škola, vrtić ili jaslice (20,9%), kod kuće i oko kuće (17,9%), na ulici (11,4%) te u trgovini ili hotelu (0,9%). Dječaci stradavaju najviše na igralištima, klizanju i na bazenima (37,1% dječaka), dok djevojčice najviše stradavaju u parkovima, kampovima i na plažama (42,4% djevojčica). Način nastanka ozljede uglavnom je pad (49,3%) koji je najčešće nastao klizanjem i koturaljkanjem (rolanjem) (32,3% svih padova). U 20,4% djece uzrok ozljede su guranje i udarac. Najmanji postotak (9,5%) djece ozlijeđen je u prometu i to vozeći bicikl. Sportske su aktivnosti uzrok nastanka ozljede u 53,7% slučajeva. One su najvažniji uzrok nastanka ozljede palčane kosti u dječjoj populaciji i padovi u toku sporta glavni su mehanizam nastanka ozljede. Dječaci najviše stradavaju u dobi od 12 godina, a djevojčice u dobi od 10 godina pa su to dobne skupine u kojima je potrebno najviše djelovati. Preventivno djelovanje potrebno je usmjeriti na ozljede nastale u parkovima, školi i sportskim aktivnostima.Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011–2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the injury was caused by pushing and hitting. The smallest percentage (9.5%) of children were injured in traffic accidents while riding a bike (only one child was hit by a car). Sport related activities caused injuries in 53.7% of the cases. Sport activities are the most important cause of the radial fractures in the pediatric population and falls during sports are the main mechanism of injury. The peak incidence is at 12 years for boys and at 10 years for girls, so intervention and/or prevention should be aimed at the age groups. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities

Rezultati liječenja prijeloma klavikula u djece

Treatment of clavicle fracture is principally outpatient. Operative treatment is accompanied by the need for more x-rays and possible complications. Fractures with absolute indications for operative treatment occur only sporadically and these indications are relatively clear, but children often undergo surgery because of relative indications (shortening, fragment displacement, multifragmentary fractures), which are open to debate. In a retrospective study on 256 children, of 44 (17%) patients that received operative treatment only one 17-year-old boy had an absolute indication for surgical intervention. Other indications were fragment distraction (22 mm on average), age, associated injuries, and multifragmentary fracture. The placement of K-wire of appropriate thickness is often difficult, since the wire tends to bend and break, and patients have to undergo two additional operations of plate and screw fixation and later removal. In this retrospective study, we considered the advantages of using titanium or an elastic steel pin. All patients had favorable outcome, although some experienced numbness around the operation scar (4.5%), skin infections around the wire (15%), and/or the implanted K-wire damage (7%).Liječenje fraktura klavikule je prevenstveno ambulantno. Operativno liječenje zahtijeva dodatne rentgenske snimke i praćeno je mogućim komplikacijama. Frakture s apsolutnom indikacijom za operativno liječenje se pojavljuju sporadično i te indikacije su jasne, ali često djeca budu operirana zbog relativnih indikacija koje nisu sasvim jasne. U retrospektivnoj studiji na 256 djece, od kojih je 44 (17%) operativno liječeno, samo jedan dječak od 17 godina je imao apsolutnu indikaciju za operaciju. Ostale indikacije su bile distrakcija (prosječno 22 mm), dob, udružene ozljede i multifragmentarne frakture. Postavljanje Kirschnerove žice odgovarajuće debljine je često nemoguće zbog savijanja i pucanja žice pa bolesnici moraju ići na dva dodatna zahvata, fiksaciju pločicom i vijcima i vađenje osteosintetskog materijala. U sklopu ove studije razmotrili smo prednosti korištenja titanskog čavla. Svi bolesnici su imali dobar ishod, iako se u određenom broju operiranih pojavila utrnutost oko ožiljka (4,5%), infekcija rane (15%) i oštećenje Kirschnerove žice (7%)

CLAVICLE FRACTURES IN CHILDREN – CIRCUMSTANCES AND CAUSES OF INJURY

Prijelomi ključne kosti u djece dva su puta češći nego u odraslih i čine 10 – 15% svih prijeloma dječje dobi. Velika pojavnost ovog prijeloma opravdava propitivanja o okolnostima i uzrocima nastanka, odnosno lokacijama na kojima se djeca ozljeđuju. U radu se analizira 256-ero djece s prijelomom klavikule liječene u razdoblju od 2008. do 2013. godine. Način, uzrok i mjesto ozljede kodirani su MKB-10 klasifikacijom s pomoću šifara vanjskih uzroka pobola. Prema okolnostima, svi prijelomi klavikule nastali su u okolnostima nenamjernog ozljeđivanja. Vanjski uzroci pripadaju jednoj od dvije podskupine: šifre (V01-V99) ozljede u prometu ili šifre (W00-X59) nezgode i nesreće. U prometu je prijelome zadobilo 24-ero (9,4%), a u nezgodama 232-je (90,6%) djece. Od prijeloma nastalih nezgodom u 204-ero djece prijelom je izazvan padom (W00-W19), 123-je njih palo je u razini, a 81 dijete s visine. Izravni udarac druge osobe ili udarac tupim predmetom bili su uzrok prijelomu kod 28-ero djece. Prema mjestu na kojem su prijelomi nastali, dominiraju ozljede zadobivene kod kuće, zatim na ulici pa ozljede na rekreacijskome mjestu, a najmanju skupinu čine ozljede u školi ili vrtiću. Bicikl je uzrok nastanka prijeloma ključne kosti u 48-ero djece i čini 18,7% svih prijeloma klavikule u naše djece. Od 256-ero djece njih 47-ero (18,4%) prijelom je zadobilo u sportskim aktivnostima: na nogometu 30-ero, na borilačkim sportovima (hrvanje, judo, karate) 10-ero, na hokeju troje, na košarci i gimnastici po dvoje djece. Predškolska djeca najčešće se ozljeđuju dok se za njih doma skrbe roditelji. Školska su djeca za trajanja škole primjereno zaštićena, a izvan škole i dalje često stradavaju u prometu i sportskim aktivnostima. U adolescenata najčešće su ozljede u prometu i na cesti (vožnja bicikla), slijede sportske, a ozljede kod kuće tek sporadično.Clavicle fractures in children occur twice as often as in adults. During a child’s growth period they account for 10–15% of all fractures sustained. The questions which should be asked are how these fractures are sustained and under which circumstances are the children injured. In the study 256 children with clavicle fractures treated during the period 2008 – 2013 were analyzed. The underlying cause and place of injuries were classified using the ICD-10 classification system, using environmental causes of injury. The circumstances were in each case accidental injury. Environmental causes were traffic accidents (V01-V99) or mishaps/accidents (W00-X59). Fracture injuries were caused in traffic accidents in 24 (9.4%), and in mishaps/accidents in 232 (90.6%) children. Of the injuries caused by mishaps/accidents, in 204 children these were caused by falls (W00-W19). In 123 of them the injuries were caused by falls from a ground level, and in 81 were from a greater height. Direct blow injuries, caused by another person or a blunt instrument, weere the causes of fractures seen in 28 children. Place of fracture sustainment was dominantly at home. This was followed by injuries sustained outside in recreational areas, while least were suffered at school or kindergarden facilities. Bicycle riding was the cause of clavicle fractures in 48 children, which was 18.7% of all fractures seen. Sports related injuries and fractures were seen in 47 (18.4%) out of 256 children: 30 in football, 10 in defensive sports (wrestling, judo, karate), three in hockey, while basketball and gymnastics accounted for two each. Preschool children were injured more often while in the care of their parents while school aged children were adaquately protected, but in after-school activities they were often injured. The most common injuries after school were those suffered in traffic accidents and recreational sports activities. In the adolescent period, the most common injuries seen were again those in traffic accidents, bicycle riding, recreational sports activities and injuries sustained at home

Prijelom klavikule u djece – okolnosti i uzroci nastanka [Clavicle fractures in children - circumstances and causes of injury]

Clavicle fractures in children occur twice as often as in adults. During a child's growth period they account for 10-15% of all fractures sustained. The questions which should be asked are how these fractures are sustained and under which circumstances are the children injured. In the study 256 children with clavicle fractures treated during the period 2008-2013 were analyzed. The underlying cause and place of injuries were classified using the ICD-10 classification system, using environmental causes of injury. The circumstances were in each case accidental injury. Environmental causes were traffic accidents (V01-V99) or mishaps/accidents (W00-X59). Fracture injuries were caused in traffic accidents in 24 (9.4%), and in mishaps/accidents in 232 (90.6%) children. Of the injuries caused by mishaps/accidents, in 204 children these were caused by falls (W00-W19). In 123 of them the injuries were caused by falls from a ground level, and in 81 were from a greater height. Direct blow injuries, caused by another person or a blunt instrument, weere the causes of fractures seen in 28 children. Place of fracture sustainment was dominantly at home. This was followed by injuries sustained outside in recreational areas, while least were suffered at school or kindergarden facilities. Bicycle riding was the cause of clavicle fractures in 48 children, which was 18.7% of all fractures seen. Sports related injuries and fractures were seen in 47 (18.4%) out of 256 children: 30 in football, 10 in defensive sports (wrestling, judo, karate), three in hockey, while basketball and gymnastics accounted for two each. Preschool children were injured more often while in the care of their parents while school aged children were adaquately protected, but in after-school activities they were often injured. The most common injuries after school were those suffered in traffic accidents and recreational sports activities. In the adolescent period, the most common injuries seen were again those in traffic accidents, bicycle riding, recreational sports activities and injuries sustained at home