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Results

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.

 

Overall results for humeral fractures

  • Out of 540 studies reviewed, 14 studies addressed humeral fractures 1-14
  • Study designs:
    • 9 cross-sectional 1,2,3-5,10-13
    • 3 case-control 8,9,14
    • 2 case study / case series 6,7
  • Age range: 0 – 12 years
    • 0 – 20 years (one study) 5
  • No study addressed disabled children
  • Influence of ethnicity and socio-economic group: no difference in ethnicity or socio-economic status was reported in one study 9

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References

  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. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  4. 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]
  5. Loder RT, Feinberg JR. Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids' inpatient database. Journal of Pediatric Orthopedics. 2007;27(4):421-426 [Pubmed] (Erratum in Journal of Pediatric Orthopedics. 2008;28(6):699)
  6. Merten DF, Kirks DR, Ruderman RJ. Occult humeral epiphyseal fracture in battered infants. Pediatric Radiology. 1981;10(3):151-154 [Pubmed]
  7. 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]
  8. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  9. 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]
  10. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  11. 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]
  12. 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]
  13. Thomas SA, Rosenfield NS, Leventhal JM, Markovitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991;88(3):471-476 [Pubmed]
  14. 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]

Meta-analysis

  • Of the studies included up to 2012, four were suitable for meta-analysis 1,3,5,6
  • Since 2013, two separate meta-analyses have been conducted, one for age 0-18 months 2-6 and one for 18-48 months 2,4-6
  • There was no heterogeneity between the studies of children aged 0-18 months (I2=0%)
  • For children aged 0-18 months with confirmed or suspected abuse the positive predictive value (PPV) of a humeral fracture is 43.8% (95% confidence interval 27.6-59.9)
  • The largest case-control study addressing this 2 highlighted that age less than 18 months, in conjunction with prior injury and suspicious history are significant indicators of an abusive aetiology
  • For children aged 18-48 months, the heterogeneity between studies was low (I2=28.8%) and the PPV of a humeral fracture due to suspected or confirmed abuse was only 1.8% (95% confidence interval 0-3.9)

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References

  1. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  2. 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]
  3. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  4. 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]
  5. 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]
  6. Thomas SA, Rosenfield NS, Leventhal JM, Markovitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991;88(3):471-476 [Pubmed]

 

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