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Dating fractures in infants

K E Halliday1, N J Broderick, J M Somers

  • 1Department of Radiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK. kath.halliday@nuh.nhs.uk

Clinical Radiology
|July 19, 2011
PubMed

Insights

Radiologists found subperiosteal new bone formation (SPNBF) reliable for dating infant fractures after 11 days. Other fracture healing signs showed poor agreement and were unreliable for determining fracture age in children.

Area of Science:

  • Pediatric Radiology
  • Orthopedic Imaging
  • Skeletal Development

Background:

  • Accurate dating of pediatric fractures is crucial for clinical management.
  • Radiological assessment of fracture healing in infants presents unique challenges.
  • Interobserver variability in interpreting fracture healing signs can impact diagnosis.

Purpose of the Study:

  • To determine the timing of radiological fracture healing signs in infants with known injury dates.
  • To evaluate interobserver agreement on these radiological signs.
  • To identify reliable indicators for estimating fracture age in young children.

Main Methods:

  • Retrospective analysis of 161 images from 37 long bone fractures in 31 infants (0-44 months).
  • Independent assessment by three pediatric radiologists.
  • Evaluation of specific features: soft-tissue swelling, subperiosteal new bone formation (SPNBF), fracture line definition, callus presence/definition, and endosteal callus.

Main Results:

  • Moderate interobserver agreement was observed for most assessed features.
  • Subperiosteal new bone formation (SPNBF) was consistently seen after 11 days post-injury.
  • SPNBF was uncommon before 11 days, though observed as early as 4 days in one case.

Conclusions:

  • Subperiosteal new bone formation (SPNBF) is a reliable radiological sign for dating infant fractures after 11 days.
  • Other commonly used criteria for fracture dating in infants are not reproducible or are poor discriminators of fracture age.
  • SPNBF offers a more consistent marker for assessing fracture age in pediatric populations.
Abstract

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