A study of radiological features of healing in long bone fractures among infants less than a year

Area of Science:

• Pediatric Radiology
• Orthopedic Trauma
• Forensic Osteology

Background:

• Accurate dating of infant long bone fractures is crucial for clinical and forensic purposes.
• Existing methods for fracture dating in infants are limited, particularly for incomplete fractures.
• Radiographic signs of fracture healing offer potential for developing a reliable dating timeline.

Purpose of the Study:

• To establish a chronological timetable for the radiographic signs of long bone fracture healing in infants under 1 year of age.
• To utilize defined radiographic features of healing (periosteal reaction, callus, bridging, remodeling) for dating fractures.
• To provide a novel tool for the accurate assessment of fracture age in pediatric patients.

Main Methods:

• Retrospective analysis of 59 digital image series of long bone fractures in 40 infants (2006-2013).
• Independent scoring of four pre-defined healing features (periosteal reaction, callus, bridging, remodeling) by three radiologists using a 3-point scale.
• Documentation of the time of first appearance, peak presence, and last observation of each healing feature.

Main Results:

• High inter-radiologist agreement (kappa 0.64-0.85) was achieved for scoring healing features.
• Established time ranges for the majority of cases: periosteal reaction (9-49 days), callus (9-26 days), bridging (15-67 days), and remodeling (51-247 days).
• Identified a consistent sequence of radiographic changes indicative of fracture healing in complete fractures.

Conclusions:

• This study presents the first timetable of radiographic features for long bone fracture healing in young infants.
• While dating incomplete fractures remains challenging, a predictable sequence exists for complete fractures.
• The developed timetable can aid in more accurate age determination of fractures in infants.