Fractures in children younger than 18months

Abstract

Fractures in children younger than 18 months occur before the usual walking age. The prognosis is favourable across fracture types and circumstances of occurrence. The cause is obvious in obstetrical injuries, whose risk factors have been well documented. Diaphyseal fractures are easy to recognise, whereas challenges may arise with the diagnosis of physeal injuries. Fractures occurring after the neonate is discharged home may be due to accidental falls related to clumsiness on the part of the carers. Other possibilities, however, are child abuse and abnormal bone fragility. Thus, the aetiological diagnosis has major medical, social, and legal implications. Identifying the aetiology is often extremely difficult and benefits from the involvement of a multidisciplinary team. The literature review presented herein is designed to assist orthopaedic surgeons in the diagnosis and management of children with fractures before 18 months of age, in compliance with French legislation, which has undergone major changes over the last quarter century.

A Rare Presentation of an Isolated Radius Shaft Fracture in a Two-Month-Old Child: Dilemmas and Management

“…The common causes of fractures in children under 18 months of age are accidental falls, child abuse, and abnormal bone fragility [ 1 - 3 ]. Our case presented to the emergency room with isolated forearm swelling and normal movements in the rest of the body.…”

“…Fractures heal consistently and very rapidly. The outcome is usually good with bone union seen within three to four weeks for metaphyseal fractures and four to six weeks for diaphyseal fractures [ 1 ]. Despite the bone union in our case, we are still following up on the case closely.…”

“…Apart from obstetric fractures, it is rare for an orthopaedic surgeon to encounter fractures in children under six months of age [ 1 ]. A few reports have described 9% clavicular fractures in vaginal deliveries [ 1 ]. Proximal and distal humerus physeal injuries and femur and tibial fractures have been noted in children aged 18 months [ 2 ].…”

Fiziyel yaralanmalara genel yaklaşım

“…Büyüme duraklaması en sık distal femur ve distal tibiada görülür. [15] Fizin tamamında gelişen bir büyüme duraklaması, ekstremitede boy eşitsizliğine neden olur. Fiz hattında büyümede kısmi durma ise, açısal deformitelere veya eklem yüzeyinde deformasyona yol açar.…”

Do bone mineral content and density determine fracture in children? A possible threshold for physical activity

“…In a small subsample of the G21 cohort (n = 74), the reproducibility of fracture report by parents within 1 year was 95%. For analysis, all fractures sustained prior to 2 years of age (n = 32) were excluded as these are most probably due to severe trauma unrelated to bone quality or child behavior, such as delivery injuries, child abuse, or accidental falls due to caregiver's negligence (25,26). Anthropometrics and Body Composition Assessment Anthropometric measures at 7 years of age were obtained by trained interviewers while children stood barefoot in light indoor clothing.…”