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Humeral fracture in non-ambulant infants-a possible accidental mechanism
John M Somers1, Katharine E Halliday, Stephen Chapman
1Radiology Department, Nottingham University Hospitals, B floor West Block, Queen's Medical Centre, Derby Road, Lenton, Nottingham, NG7 2UH, UK, jsomers@ntlworld.com.
Insights
Humeral fractures in infants may occur when they roll over, trapping their arm. This study investigates this rare mechanism in non-ambulant infants, suggesting it as a potential cause of injury.
Area of Science:
- Pediatric orthopedics
- Infant trauma research
- Mechanism of injury studies
Background:
- Humeral fractures in non-ambulant infants (<1 year) are often presumed non-accidental injuries.
- A rare accidental mechanism involving rolling over was previously described in 1996.
Observation:
- Seven cases of isolated humeral fractures in non-ambulant infants (4-7 months) are presented.
- Caregivers reported fractures occurring during self-initiated rolling, trapping the arm.
Findings:
- The caregiver's description suggests a possible mechanism where infants can sustain humeral fractures through self-rolling.
- No independent witness or video evidence confirmed the rolling mechanism in these cases.
Implications:
- This mechanism warrants further investigation as a rare cause of infant humeral fractures.
- Challenges the assumption that limited mobility precludes self-inflicted injury in infants.
- Highlights the need for careful evaluation of accidental mechanisms in infant fractures.
Background:
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position.
Objective:
To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party.
Materials And Methods:
We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present.
Results:
In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party.
Conclusion:
There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required.
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