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Fractures

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Review last updated in February 2015

 

Fractures have been recorded in as many as 55% of young children who have been physically abused 1-3, 18% of whom have multiple fractures 3. Additional large scale studies have enabled a revised meta-analysis by age group which may be of value to practitioners in determining probability of abuse for a child presenting with unexplained fractures 4.

 

There are increasing numbers of high quality studies being published in this field. These continue to address the value of yield of skeletal surveys in different populations in addition to detailing specific fracture patterns associated with abuse. One new study addresses healing of fractures in very young infants addressing a previously ignored area, contributing to the timetable for the dating of fractures

 

Fractures in physical child abuse denote severe assault and it is essential that they are identified if present. Changing guidelines with regard to cardiopulmonary resuscitation (CPR) in infants may have a bearing on the risk of rib fractures and recent studies have addressed this.

 

The review seeks to answer the following review questions:

  1. Which fractures are indicative of abuse?

  2. What is the evidence for radiological dating of fractures in children?
  3. What radiological investigations should be performed to identify fractures in suspected child abuse?
  4. Does cardiopulmonary resuscitation cause rib fractures in children?

 

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References

  1. Kogutt MS, Swischuk LE, Fagan CJ. Patterns of injury and significance of uncommon fractures in the battered child syndrome. American Journal of Roentgenology, Radium Therapy and Nuclear Medicine. 1974;121(1):143-149 [Pubmed citation only]
  2. Loder RT, Bookout C. Fracture patterns in battered children. Journal of Orthopaedic Trauma. 1991;5(4):428-433 [Pubmed]
  3. Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? American Journal of Roentgenology. 2011;197(1):W159-W163 [Pubmed]
  4. Maguire S, Cowley L, Mann M, Kemp A. What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005 - 2013. Evidence Based Child Health: A Cochrane Review Journal. 2013;8(5):2044-2057. [Abstract available from Wiley online library]

 

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