Fractures associated with non-accidental injury--an orthopaedic perspective in a local regional hospital

To identify the potential risk factors for fractures due to non-accidental injury in children, and to alert clinicians and health care workers to the diagnosis of child abuse.

Retrospective review.

Regional hospital, Hong Kong.

Children who were admitted to the hospital with a clinical diagnosis of child abuse with associated fracture(s) between January 1996 and April 2004.

Demographic data, site of fractures, and investigations performed.

Of the 377 children presented with non-accidental injuries, 29 (15 male, 14 female) had bone fractures. The mean age of the 29 children at the time of injury was 5 years and 5 months. Of the nine records showing pregnancy, seven were unplanned. Approximately 75% of the families were living in public housing estates, and 28% were receiving social security subsidy. Over half (52%) of the abused children were aged 3 years or less. A total of 78 fractures were documented with a mean of 2.7 fractures per child. The most common sites of fracture were the forearm (29%), followed by the ribs (24%). Most long bone fractures occurred in those aged 3 years or less. Fractures were detected by skeletal survey and bone scan for 90% of the children.

A number of potential risk factors were identified in children with fractures associated with non-accidental injury. They included age younger than 3 years, lower socio-economic status, presentation with long bone fracture, and unplanned pregnancy. Bone scan and skeletal survey are mutually complementary, and both should be performed in cases of suspected child abuse. Subsequent management requires cooperation of multi-disciplinary health care professionals.