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Accidental and nonaccidental femur fractures in children

Published on Jul 1, 2000in Clinical Orthopaedics and Related Research4.154
· DOI :10.1097/00003086-200007000-00014
Susan A. Scherl6
Estimated H-index: 6
,
Lisa Miller2
Estimated H-index: 2
+ 3 AuthorsPaul Tornetta54
Estimated H-index: 54
Abstract
A retrospective review of 207 patients younger than 6 years of age who sustained nonpathologic diaphyseal femur fractures was done, which emphasized the characteristics of accidental versus nonaccidental injury. There were 214 fractures in 123 boys and 83 girls (the gender of one patient was unknown). The average age of the patients was 2.73 years. Mechanisms of injury were pedestrian struck by a car (62 patients), falls (92 patients), and motor vehicle accidents (10 patients). Nineteen patients did not have a history of trauma. Seventy-six cases were investigated for child abuse. The results of 13 investigations were positive. Overall, the morphologic features of the fractures were transverse (38%), spiral (27%), and oblique (17%). In the investigated group, 27% of the fractures were transverse, 39% were spiral, and 15% were oblique. In those cases with positive results of the investigation, 36% of the fractures were transverse, 36% were spiral, and 7% were oblique. Although transverse fractures are most common in accidental and nonaccidental injuries, many practitioners think spiral fractures are pathognomonic of abuse. The current data show that although spiral fractures were less common than transverse fractures overall, and no more common in the cohort of patients in whom the results of the child abuse investigations were positive, they were overrepresented in the cohort that was investigated. This suggests that spiral fractures are viewed as particularly suspicious, which may lead to missed cases of nonaccidental injury in children with transverse fractures. Language: en
  • References (47)
  • Citations (70)
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References47
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Increased awareness of child abuse has led to better understanding of this complex problem. However, the annual incidence of abuse is estimated at 15 to 42 cases per 1,000 children and appears to be increasing. More than 1 million children each year are the victims of substantiated abuse or neglect, and more than 1,200 children die each year as a result of abuse. The diagnosis of child abuse is seldom easy to make and requires a careful consideration of sociobehavioral factors and clinical findi...
87 CitationsSource
We performed a retrospective review of 34 humerus shaft fractures (HSFs) in children younger than 3 years to determine the frequency of child abuse in young children with this injury. Data were obtained from hospital records (including previous and subsequent emergency, clinic, and inpatient notes), radiographs, and county childprotective services. Cases were reviewed independently by four physicians and were classified as probable abuse, probable not abuse, and indeterminate. Only 18% were clas...
60 CitationsSource
Fractures are one of the most common manifestations of child abuse. Pediatricians and other physicians caring for children must have a clear understanding of the injury patterns sustained by children in abusive situations and be able to recognize those injuries. A thorough history and physical examination and accurate radiographic interpretation are essential. Early identification of nonaccidental trauma is imperative because proper intervention has been shown to be effective. Language: en
28 CitationsSource
#1B. F. Hughes (Johns Hopkins University)H-Index: 2
Last. Thompson Jd (Johns Hopkins University)H-Index: 3
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Twenty-three consecutive children with isolated closed femur fractures treated with early spica casts were studied to determine the impact of this treatment on family, school, and other support systems. Mobility was identified by families as the major problem. In families with two working parents, a mean of 3 weeks time off work was needed. None of the children was accepted into school in cast. Home tutoring for a mean of 8 weeks was used, with 48 tutor-hours per child. Despite this, none of the...
82 CitationsSource
The billing records of 58 children and adolescents with femoral shaft fractures treated during 1990 were analyzed. The treatment groups included early spica casting, skin traction, skeletal traction, home traction, and intramedullary rodding. The medical charges included both the hospital and physician (orthopedist, radiologist, and anesthesiologist) components. The total charges were lowest for the early spica group ($5,494) and highest for the skeletal traction and intramedullary rodding group...
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SummaryThe fracture patterns of 3,350 children with 3,413 limb fractures admitted to one center from 1986 to 1990 were analyzed retrospectively. The overall boy-to-girl ratio was 2.7:1, rising to 5.5:1 in the adolescent group. Distal radius fracture was the most common fracture (19.87%), followed by
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#1John M. LeventhalH-Index: 45
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• Objective. —To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. Design. —Case series. Setting. —Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). Patients. —Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse regi...
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#1Areta Kowal-Vern (Loyola University Medical Center)H-Index: 21
#2Thomas P. Paxton (Loyola University Medical Center)H-Index: 3
Last. Richard L. Gamelli (Loyola University Medical Center)H-Index: 29
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One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62...
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#1Ward WtH-Index: 1
#2Levy JH-Index: 1
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Twenty-five children ranging in age from 6-16 years underwent AO compression plate fixation for treatment of a femur fracture. Generally, the most common reason for plate fixation was to simplify nursing care and rehabilitation of children with an associated severe head injury or polytrauma. Twenty-three fractures healed in 11 weeks on the average, most by periosteal bone formation. Leg length discrepancy was not a clinical problem. Nursing care and polytrauma rehabilitation were simplified in a...
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#1Adel NafeiH-Index: 11
#2Gerhardt TeichertH-Index: 1
Last. Ivan HvidH-Index: 39
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We report 144 femoral shaft fractures (FSF) in 138 children less than 15 years old. The boy/girl ratio was 2.8:1. The incidence rate was 28 per 100,000 child-years. Young children (less than 3 years) had the highest incidence rates. The most common etiology was trauma due to traffic accidents (43.1%) and falls (42.2%). Falling off bicycles contributed to 4.9%, direct trauma to 3.5%, and jamming to 5.6% of fractures. Involvement of children in traffic accidents and the number of FSFs due to traff...
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#1Marie-Louise H. J. Loos (VU: VU University Amsterdam)
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The majority of paediatric femur fractures result from accidental trauma; however, it is important to consider non-accidental trauma, especially in pre-ambulatory children. We study whether irrelevant contextual information subconsciously influences conclusions of healthcare professionals with respect to whether observations provide evidence for non-accidental trauma. A survey with nine radiographs of femur shaft fractures was designed. Two different clinical histories (vignettes) with contextua...
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#1Daniel M. Lindberg (Anschutz Medical Campus)H-Index: 1
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Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications, and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in the understanding, evaluation, and management of children with suspected AHT. Several specific topics are examined as follows: serious or fatal injurie...
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#2Simon G. F. RobbenH-Index: 22
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#1Angela Thompson (University of Louisville)H-Index: 4
#2Gina Bertocci (University of Louisville)H-Index: 19
Last. Craig Smalley (University of Louisville)H-Index: 4
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Abstract Background Femur fractures are a common orthopedic injury in young children. Falls account for a large portion of accidental femur fractures in young children, but there is also a high prevalence of femur fractures in child abuse, with falls often provided as false histories. Objective information regarding fracture potential in short distance fall scenarios may aid in assessing whether a child's injuries are the result of abuse or an accidental fall. Knowledge of femur loading is the f...
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#1Laura A. Leaman (PSU: Pennsylvania State University)H-Index: 1
Last. Adam Y. Nasreddine (PSU: Pennsylvania State University)H-Index: 1
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The aim of this study was to identify seasonal variation in nonaccidental injury (NAI) in children <1 year of age. Fifty consecutive patients age ≤12 months with a fracture were identified between January 2010 and June 2012. Patients' records were reviewed for demographic, clinical, and radiographic data. Zip code was used to collect socioeconomic data. Out of 50 patients included in the study, fractures in 16 (32%) patients were reported for abuse. NAI was reported in 2/13 (15%) fracture cases ...
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#1Gina Bertocci (University of Louisville)H-Index: 19
#2Angela Thompson (University of Louisville)H-Index: 4
Last. Mary Clyde Pierce (Children's Memorial Hospital)H-Index: 21
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Abstract Purpose The objectives of this study were to describe fracture morphology resulting from common loading mechanisms such as bending and torsion in immature bone and to identify differences in the energy required to produce various fracture types under these two loading mechanisms using an immature porcine animal model. Methods Twenty-six in vitro immature porcine femora were mechanically tested in 3-point-bending and torsion. Femur specimens were tested with and without soft tissue and a...
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#1Susan A Scherl (UNO: University of Nebraska Omaha)
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Last. N.S. Neki
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BACKGROUND: Elastic stable intramedullary nailing for the treatment of Pediatric Femur diaphyseal fractures was introduced by Prevot and colleagues in 1979. The technique offers several advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low rate of complications. OBJECTIVES: To study the union rates and functional outcome of closed reduction and internal fixation of pediatric diaphyseal fractures of femur with TENS. DESIGN: ...
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