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Soft tissue swelling with fractures: abuse versus nonintentional
L M dos Santos1, G Stewart, K Meert
1Children's Hospital of Michigan, Division of Emergency Medicine, Detroit 48201, USA.
Pediatric Emergency Care
|August 1, 1995
Summary
Children with long bone fractures show significant swelling. However, fractures due to abuse and/or neglect present with less swelling than unintentional injuries, suggesting unreliable injury history.
Area of Science:
- Pediatric Orthopedics
- Child Abuse and Neglect
- Trauma Care
Background:
- Accurate assessment of pediatric fractures is crucial.
- Distinguishing between intentional and unintentional injuries can be challenging.
- Swelling is a common post-fracture symptom.
Purpose of the Study:
- To quantify postfracture swelling in long bone fractures in children.
- To investigate the correlation between suspected abuse and/or neglect (A/N) and the degree of swelling.
- To determine if swelling can serve as an indicator of injury type.
Main Methods:
- Prospective study of 37 pediatric patients (<11 years) with long bone fractures.
- Measurement of limb circumference increase due to swelling, using the uninjured limb as a control.
- Comparison of swelling between groups categorized as A/N and non-intentional injuries.
Main Results:
- Mean postfracture swelling was 9.6 +/- 7.1% increase in circumference.
- Patients with suspected A/N had significantly less swelling (3.8 +/- 3.6%) compared to non-intentional injuries (11.2 +/- 7.0%), even after adjusting for injury age.
- No significant difference in reported injury age between the groups.
Conclusions:
- Pediatric long bone fractures typically present with a mean swelling of 9.6%.
- Injuries resulting from A/N exhibit less swelling than non-intentional fractures.
- The reduced swelling in A/N cases may indicate that the reported history and/or time of injury is unreliable.