Falls and fractures in early childhood: anatomical and developmental factors in a southeast European primary care cohort

Abstract

Background: Unintentional injuries are a major contributor to morbidity and healthcare burden in early childhood. While falls and fractures are globally recognized as the most common pediatric injuries, region-specific data from primary care emergency settings in Southeast Europe remain scarce. The objective was to investigate the mechanisms, anatomical distribution, and contextual factors of injuries in children aged 0 to 6 years treated in a primary care pediatric service in Bosnia and Herzegovina. Methods: This retrospective study included ninety-nine children aged 0 to 6 years who presented with injuries to a primary care service between September 2019 and December 2024. Data were collected from medical records and included age, sex, mechanism of injury, type of injury, anatomical site, supervision, home safety, and treatment outcome. Descriptive statistics and chi-square tests were used to analyze associations between demographic variables and injury characteristics. Logistic regression was also applied to examine predictors of fracture occurrence, adjusting for age group and sex. Results: Falls were the leading cause of injury, accounting for 69.7% of all cases, with the highest number recorded in the 13- to 36-month age group. Fractures were the most frequent injury type, of which 74.4% affected the upper limbs, particularly the radius and humerus. Head injuries were more prevalent among infants, while boys experienced a higher overall injury rate. No statistically significant associations were found between injury occurrence and supervision or home safety, largely due to missing data and limited sample size. Conclusion: Falls were the predominant cause of injury in early childhood, with upper limb fractures being common, especially among toddlers. While these findings provide important insights for prevention and pediatric emergency care planning in Bosnia and Herzegovina, larger prospective studies are needed to validate and extend these results.