Understanding forearm fractures in young children: Abuse or not abuse? |
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| Institution: | 1. Emergency Services, Children''s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA;2. Research and Sponsored Programs, Children''s Hospitals and Clinics of Minnesota, Minneapolis, MN;3. Center for Injury Research and Policy, The Research Institute at Nationwide Children''s Hospital, Columbus, OH;4. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH |
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| Abstract: | This retrospective study describes the characteristics and mechanisms of forearm fractures in children <18 months adding to the evidence-base about forearm fractures. It also examines which features of forearm fractures in young children may help discriminate between abusive and noninflicted injuries. Electronic medical records were reviewed for eligible patients evaluated between September 1, 2007 and January 1, 2012 at two children's hospitals in Chicago, IL. The main outcome measures were the type of fracture and the etiology of the fracture (abuse versus not abuse). The 135 included patients sustained 216 forearm fractures. Most were buckle (57%) or transverse (26%). Child protection teams evaluated 47 (35%) of the patients and diagnosed 11 (23%) as having fractures caused by abuse. Children with abusive versus non-inflicted injuries had significant differences in age (median age 7 versus 12 months), race, and presence of additional injuries. Children with abusive forearm fractures often presented without an explanation or a changing history for the injury. Children with non-inflicted forearm fractures often presented after a fall. No particular type of forearm fracture was specific for child abuse. Any forearm fracture in a young child should be evaluated with special attention to the details of the history and the presence of other injuries. Young age, additional injuries, and an absent or inconsistent explanation should increase concern that the fracture was caused by child abuse. |
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| Keywords: | Fractures Forearm injuries Child abuse |
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