Patterns of Injury and Indicators of Abuse in Young Children With Forearm Fractures

Abstract

This retrospective study describes the patterns of injury among young children with forearm fractures in order to identify factors that should raise suspicion for child abuse. Electronic medical records were reviewed for all patients <18 months old presenting with radius and/or ulna fractures to two urban children’s hospitals between 09/01/2007 and 01/01/2012, excluding children with conditions predisposing to bone weakness. Determinations of abuse were based on evaluations by child protection teams upon presentation. The most common fracture types in the 135 patients were buckle (61% of radius fractures, 50% of ulna fractures) and transverse (26% of radius fractures, 35% of ulna fractures), usually occurring after a fall. Child protection teams evaluated 35% of patients and diagnosed 23% with abuse. Children with fractures attributed to abuse presented at a significantly younger age (median 7 versus 12 months), often with other injuries and a changing or absent history compared to children for whom abuse was ruled out. Similar fracture types were seen in both groups. In summary, buckle and transverse fractures can result from falls in young children. No fracture type is specific to abuse and clinicians should pay particular attention to the history provided and the presence of other injuries.