Controversies in the Evaluation of Young Children with Fractures

Egge, Melissa K.; Berkowitz, Carol D.

doi:10.1016/j.yapd.2010.08.002

Cited by 6 publications

(3 citation statements)

References 73 publications

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“…On the other end of the age spectrum, orthopaedic manifestations of child abuse are well characterized, although still likely underdiagnosed. [16][17][18] Along a similar vein, intimate partner violence has been associated with orbital fractures. 19,20 Analogous to the identification of fracture presentations characteristically associated with child and intimate partner abuse, this study aims to identify presenting patterns seen in association with elder abuse using a large national database.…”

mentioning

confidence: 99%

Predictors of Physical Abuse in Elder Patients With Fracture

Gardezi

Moore²,

Rubin³

et al. 2022

JAAOS Glob Res Rev

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Introduction:Elder abuse is a public health issue requiring attention. Unlike abuse in the pediatric population, predictors of elder abuse in patients with fracture have not been well defined.Methods:Elderly patients with physical abuse and fracture were abstracted using the 2007 to 2017 National Emergency Department Sample database. Univariate comparisons, multivariate regression, and adjusted odds ratios were used to determine independent predictors of elder abuse compared with nonabuse fracture controls.Results:Thirteen percent of elder physical abuse patients presenting to the emergency department had fracture. Of all patients with fracture, elder abuse patients tended to be younger; be female; belong to lower income quartiles; and have codiagnoses of volume depletion, mental disorders, dementia, and intellectual disability. Presentation with other forms of elder abuse, such as psychological abuse, neglect, and sexual abuse, and multiple fractures were also associated with elder physical abuse. Multivariate regression found elder abuse to be more likely in the setting of skull and rib fractures and less likely in the setting of femur and foot and ankle fractures.Discussion:This study identified predictors of elder physical abuse in fracture patients older than 60 years. As with pediatric abuse, heightened awareness of potential physical abuse should be considered, especially in higher risk patients.

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confidence: 99%

Predictors of Physical Abuse in Elder Patients With Fracture

Gardezi

Moore²,

Rubin³

et al. 2022

JAAOS Glob Res Rev

View full text Add to dashboard Cite

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“…A study on bruising patterns found that the location of bruises on the body in abused elderly adults were similar to those in situations of intimate partner violence . Fractures are considered to be a potential sign of interpersonal violence and child abuse, but there has been little research examining signs of elder abuse in individuals with fractures. A number of aging‐related conditions such as osteoporosis and gait instability may predispose older adults to fractures.…”

mentioning

confidence: 99%

Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures

Gironda

Nguyen

Mosqueda

2016

J American Geriatrics Society

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OBJECTIVES To examine the relationship between individual characteristics and potential correlates of elder abuse in older adults who present with fractures. DESIGN Cross-sectional analysis of deidentified data extracted from medical records. SETTING Academic medical center. PARTICIPANTS Individuals aged 65 and with a primary diagnosis of any fracture admitted to an outpatient department or emergency department (ED) in a single southern California medical center over a 36-month period (N = 652). MEASUREMENTS Participant characteristics included demographic characteristics, number of medical visits, and point of service. Corresponding International Classification of Diseases, Ninth Revision (ICD-9) codes, E-codes, and V-codes were extracted to identify cause, location, and type of fracture. The presence of 13 potential correlates of abuse as captured by ICD-9 codes were extracted and summed. Descriptive statistics and regression models were used for analyses. RESULTS Mean age of participants was 77.2, 58% were female (58%), 60% were white (60%), and 46% had one or more potential correlates of abuse. In bivariate analyses, older age (≥80), dementia, seeking care in the ED (vs inpatient or outpatient clinics), only one visit to a medical facility (vs multiple visits) in the 36-month study period, cause of fracture as something other than a fall, and fractures of the head or face were more likely to have at least one correlate of abuse. In logistic regression, dementia (B = 0.794, standard error (SE) = 0.280); seeking care in the ED (vs outpatient or outpatient clinics) (B = 1.86, SE = 0.302); at least two visits to a medical facility (vs multiple visits) (B = 0.585, SE = 0.343); and fracture of the back (B = 0.730, SE = 0.289), head (B = 1.22, SE = 0.333), and face (B = 1.28, SE = 0.474) were associated with the presence of at least one correlate of abuse. CONCLUSION Certain characteristics in older adults with fracture are associated with potential correlates of abuse. Medical practitioners should have a heightened awareness when these signs are present. J Am Geriatr Soc 64:1651–1655, 2016.

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“…At postmortem, collection of samples for fibroblast culture (skin biopsy) and DNA sequencing is indicated. It must be noted that 10% of cases of OI are not detectable by the current methods of genetic testing (111).…”

Section: Discussionmentioning

confidence: 99%

Are There Hallmarks of Child Abuse? I. Osseous Injuries

Walker

Kepron

Milroy

2016

Academic Forensic Pathology

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Fractures are commonly found in cases regarded as child abuse. The most commonly encountered fractures are to the ribs and the metaphyses. This paper examines the specificity of the classical metaphyseal lesion (CML) and rib fractures as hallmarks of child abuse. Recently, vitamin D deficiency (rickets) has been proposed as an alternative cause for the appearances typically described in CML. The literature in this area is examined. Rib fractures have also been highly associated with child abuse, particularly posterior rib fractures. As well as metabolic bone disease, resuscitation has been examined as a cause of rib fractures in young children. The current literature remains strongly supportive of rib fractures and metaphyseal fractures being indicators of child abuse.

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Controversies in the Evaluation of Young Children with Fractures

Cited by 6 publications

References 73 publications

Predictors of Physical Abuse in Elder Patients With Fracture

Predictors of Physical Abuse in Elder Patients With Fracture

Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures

Are There Hallmarks of Child Abuse? I. Osseous Injuries

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