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A Rare Case Report on Bilateral Intertrochanteric Fractures in a Child Following Child Abuse
Raghavendra S Kembhavi1, Boblee James2
1Assistant Professor, Department of Orthopaedics, Sree Lakshmi Narayan Institute of Medical Sciences , Pondicherry, India .
Insights
Diagnosing non-accidental injury in children requires thorough evaluation. This case highlights multiple fractures in a young child, leading to surgical intervention and psychological support.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Child Abuse Forensics
Background:
- Accurate diagnosis of non-accidental injury (NAI) is crucial to prevent recurrent harm.
- Comprehensive assessment involving history, physical examination, and investigations is essential.
Observation:
- A 4-year-old female presented with a history of fall, but examination revealed multiple fractures in various healing stages.
- Radiological assessment identified both old, malunited fractures and acute bilateral intertrochanteric fractures.
Findings:
- The patient underwent surgery for the acute bilateral intertrochanteric fractures using open reduction and titanium elastic nailing.
- Postoperative follow-up showed complete radiological union within two months.
- The child received counseling from a child psychologist.
Implications:
- This case underscores the importance of a high index of suspicion for NAI in pediatric fractures.
- Timely and accurate diagnosis and management are vital for optimal outcomes.
- Multidisciplinary care, including psychological support, is essential for child abuse victims.
Abstract:
Diagnosis of non accidental injury needs careful history elicitation, proper examination and thorough workup including blood investigation and radiological assessment to avoid misdiagnosis or under diagnosis. Correct diagnosis and reporting would avoid possible similar incidents in the future. Four-year-old female child brought to our hospital by her mother with apparent history of fall from height. Following detailed examination and radiological assessment we suspected of child abuse. Child had multiple fractures in different stages of healing which included bilateral intertrochanteric fractures. Child was operated for bilateral intertrochanteric fractures which appeared relatively fresh compared to other old malunited fractures with open reduction and fixation with titanium elastic nailing and was immobilized by hip spica. Two months postoperatively, there was complete radiological union of fractures and child was being counseled by child psychologist.
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