Fracture and Nonaccidental Injury: A Case Report of a Lateral Condylar Fracture in a 13 Month Old
Helen Levin1, Gurinder Sangha, Timothy P Carey
1From the Departments of Paediatrics and Surgery, Schulich School of Medicine and Dentistry at Western University, Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.
Insights
Recognizing nonaccidental injury (NAI) in children is crucial to prevent further harm. A lateral condylar fracture in an infant, though rare, can be a sign of NAI.
Area of Science:
- Pediatric medicine
- Forensic medicine
- Orthopedic surgery
Background:
- Pediatric nonaccidental injury (NAI) is a significant clinical concern, frequently encountered in emergency departments and primary care settings.
- Failure to diagnose NAI carries substantial risks, including a 35% likelihood of subsequent injury and a 5-10% mortality rate.
- Fractures are the second most common indicator of NAI, necessitating vigilance for unusual fracture patterns in young children.
Observation:
- This report details a unique case of a lateral condylar fracture in a child nearing 13 months of age.
- This specific fracture pattern has not been previously documented as a manifestation of NAI in this age group.
Findings:
- The case highlights the importance of considering NAI even with seemingly atypical fracture presentations.
- Lateral condylar fractures in infants may represent an underrecognized sign of nonaccidental trauma.
Implications:
- Physicians must maintain a high index of suspicion for NAI in young children presenting with any fracture, regardless of apparent typicality.
- Expanding the recognition of fracture types associated with NAI can improve diagnostic accuracy and timely intervention, potentially saving lives and preventing further abuse.
Abstract:
Pediatric nonaccidental injury (NAI) is an important entity that is commonly seen in a variety of medical settings. These children often present to the emergency department or primary care physicians as the first point of contact after an NAI. There is a major risk associated with nonrecognition of an NAI, including a 35% chance of subsequent injury and a 5% to 10% risk of mortality. Therefore, it is essential for physicians to be vigilant when assessing injuries compatible with NAI, especially in infants and young children who are not able to independently express themselves. As fracture is the second most common manifestation of NAI, practitioners should be vigilant to recognize unusual fractures in atypical age ranges to aid in its diagnosis. Here, we present a novel case of a lateral condylar fracture in an almost 13-month-old-child that has not been previously associated with NAI.
