Patterns of fractures in accidental and non-accidental injury in children: a comparative study.

Abstract

The incidence and pattern of fractures in children who had been abused were compared with those of fractures sustained by children of similar ages in whom abuse had been excluded. From 1976 to 1982 there were 35 children with fractures resulting from child abuse, and all were aged under 5. Of the 826 children in the control group, seen from January to June 1981, 85% were aged over 5. Abused children were much more likely to have multiple fractures (p<0-001) and bruising of the head and neck (p<0-001).

Child injuries in Bergen, Norway

“…Children also fall on snowy and icy grounds, but the incidence of children with radial fractures in our region was still not higher than in regions with different climates. 98 The percentage of fractures in the radius and ulna related to other fracture locations was 39% in our study (27% wrist plus 12% forearm fractures), 36% in south Wales, 98 45% in Nottingham, 187 and 27% in Malmø. 171 Most distal radial fractures are easy to treat with immobilization in a cast for 3-6 weeks, and rarely cause any functional dysfunction for the child.…”

“…89 The most common fractures in children are located to the upper extremity (distal forearm, fingers, carpal and metacarpal bones and the clavicle . 85,89,97,171,187 Fractures which require in-patient hospital treatment mostly involve the distal forearm, followed by the supracondylar humerus, forearm shaft and tibial shaft. 26 Kopjar estimated that 72% of the child fractures resulted in activity restriction, with leg fractures accounting for 33% of all activity restricted days, although representing only 19% of cases.…”

“…26,85,89,97,171,187 Equally reported are also the changes in rates with age. The supracondylar fracture is most common in the first decade of life, with a peak at 7-8.…”

“…It has been estimated that one in eight children under 18 months with a fracture may be a victim of abuse. 187 Akbarnia, an orthopedic surgeon, described the specific injury pattern in victims of child abuse. 2 Bone scans may reveal both current and past evidence of bone injury.…”

Letter from Dr Christopher S Greeley

“…While the most common cause of unexplained fractures in nonambulatory infants is inflicted trauma, [10][11][12][13] Child abuse is the most frequent cause of multiple fractures in neonatal period, but bone diseases associated with increased bone fragility can be subtle or difficult to diagnose.…”