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Fracture type

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.


  • Four studies confirmed that spiral or oblique humeral fractures in children less than five years of age were strongly associated with abuse 3,7-9

  • Humeral shaft fractures were more frequently due to abuse 6
  • Supracondylar fractures were overwhelmingly due to accidents 2,6,8,9

  • Fracture dislocation of the proximal or distal humeral epiphysis was described in abused and accidentally injured children 1,4,5

    • Age range: from 0 – 7 years, the majority were under three years 1,4,5

    • Epiphyseal humeral fractures are difficult to visualise 1,4,5

    • Visualisation may be enhanced by the use of ultrasound or magnetic resonance imaging scanning 1,4,5

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  1. DeLee JC, Wilkins KE, Rogers LF, Rockwood CA. Fracture-separation of the distal humeral epiphysis. The Journal of Bone and Joint Surgery. 1980;62(1):46-51 [Pubmed]
  2. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. Journal of Pediatric Orthopaedics. 1998;18(1):38-42 [Pubmed]
  3. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  4. Merten DF, Kirks DR, Ruderman RJ. Occult humeral epiphyseal fracture in battered infants. Pediatric Radiology. 1981;10(3):151-154 [Pubmed]
  5. Nimkin K, Kleinman PK, Teeger S, Spevak MR. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings. Pediatric Radiology. 1995;25(7):562-565 [Pubmed]
  6. Pandya NK, Baldwin KD, Wolfgruber H, Drummond DS, Hosalkar HS. Humerus fractures in the pediatric population: an algorithm to identify abuse. Journal of Pediatric Orthopaedics: Part B. 2010;19(6):535-541 [Pubmed]
  7. Shaw BA, Murphy KM, Shaw A, Oppenheim WL, Myracle MR. Humerus shaft fractures in young children: accident or abuse? Journal of Pediatric Orthopaedics. 1997;17(3):293-297 [Pubmed]
  8. Strait RT, Seigel RM, Shapiro RA. Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse? Pediatrics. 1995;96(4 Pt 1):667-671 [Pubmed]
  9. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]


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