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Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse?
R T Strait1, R M Siegel, R A Shapiro
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226, USA.
Insights
Child abuse is a concern with humeral fractures in young children. Abuse was found in 36% of infants under 15 months, but only 1% of older children, highlighting the need for careful evaluation.
Area of Science:
- Pediatric Orthopedics
- Child Abuse and Neglect
- Radiology
Background:
- Humeral fractures in young children can be challenging to diagnose, with potential for abuse.
- Previous studies have reported varying frequencies of abuse in pediatric humeral fractures.
Purpose of the Study:
- To determine the occurrence and frequency of abuse in children under 3 years old presenting with humeral fractures.
- To analyze the association between specific fracture types and abuse in this age group.
Main Methods:
- Retrospective chart review of 124 children under 3 years old with humeral fractures.
- Independent evaluation of charts using established criteria for abuse, indeterminate, or not abuse classifications.
Main Results:
- Abuse was diagnosed in 36% of children under 15 months versus 1% in older children (P < .05).
- Supracondylar fractures showed a higher prevalence of abuse (20%) compared to spiral/oblique fractures (58%) in infants.
- Abuse was excluded in 73% and indeterminate in 18.5% of cases.
Conclusions:
- The prevalence of abuse in this cohort was lower than reported elsewhere, particularly in children over 15 months.
- Abuse should be considered in all infants under 15 months with humeral fractures, including supracondylar types.
- Most humeral fractures in children are accidental, especially in those older than 15 months.
Objective:
To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries.
Methods:
A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse.
Results:
Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures.
Conclusion:
The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.
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