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Fractures of the hands and feet

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.

 

  • Of 540 studies reviewed, seven studies described fractures to hands and feet 1-7
  • Age range: 1 month – 10 years
  • One comparative study found no significant difference in the rate of fractures to the hands and feet between abused and control children less than four years of age 6
  • Two cross-sectional studies showed that fractures to the hands and feet were present in 1.4% in all children less than ten years being evaluated for child abuse 3, and in 5-5.5% of children less than two years undergoing skeletal survey 1,3
    • 47/56 children with fractures to the hands and feet were aged less than two years 1,4
    • The mean age of the children with fractures to the hands was 14.1 months, range 5.6-22.4 months. The mean age of children with fractures to the feet was 10 months, range 1.3-13.6 months 3. One study showed the mean age of fractures to the hands or feet was 5 months (range 1-10 months) 1
    • The mean number of hand fractures per child was 2, range 1-4, the mean number of fractures to the feet was 1.5, range 1-3. The most common fractures were metacarpal or metatarsal 3
  • 22 fractures of the hands and feet in 11 abused infants 5
    • Torus fractures predominated
    • 7/11 infants had additional fractures of the ipsilateral extremity
  • Among sixteen infants with fractures to hands or feet metatarsels were the most common site of injury and Transverse or buckle type fractures were present in 75% 1
    • All infants with hand or feet fractures had additional fractures
  • Two case reports:
    • Six month old with fractures of second to fifth metatarsals bilaterally, and associated fractures of radius and ulna 2
    • A ten year old with multiple bilateral phalangeal fractures of different ages thought to be secondary to hyper-extension 7

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References

  1. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatric Radiology. 2015;45(1):69-80 [Pubmed]

  2. Jaffe AC, Lasser DH. Multiple metatarsal fractures in child abuse. Pediatrics. 1977;60(4 Pt 2):642-643 [Pubmed citation only]
  3. Kleinman PK, Morris NB, Makris J, Moles RL, Kleinman PL. Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse. American Journal of Roentgenology. 2013;200(3):641-4 [Pubmed]

  4. Lindberg DM, Harper NS, Laskey AL, Berger RP; ExSTRA Investigators. Prevalence of abusive fractures of the hands, feet, spine, or pelvis on skeletal survey: perhaps "uncommon" is more common than suggested. Pediatric Emergency Care. 2013;29(1):26-9 [Pubmed]

  5. Nimkin K, Spevak MR, Kleinman PK. Fractures of the hands and feet in child abuse: imaging and pathological features. Radiology. 1997;203(1):233-236 [Pubmed]
  6. 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]
  7. Rao KS, Hyde I. Digital lesions in non-accidental injuries to children. British Journal of Radiology. 1984;57(675):259-260 [Pubmed citation only]

 

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