Incorrect postulate regarding humeral fractures in non-ambulant infants

Rosado, Norell

doi:10.1007/s00247-014-3124-8

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…The modelled results in this small sample suggests that rolling over does not generate sufficient force to reach the fracture limit of the infant humerus, while rolling over from front to back without an external force. These results support the arguments of Rosado (2014) and Jenney (2014). 3,4 Rosado 3 pointed out that it is very doubtful that an infant who can hardly carry his/her own body weight against gravity will have sufficient strength to overcome the failure limit of the humerus.…”

Section: Discussionsupporting

confidence: 92%

“…Somers and his colleagues recognised these inconsistencies and were successful in their overarching goal of fuelling debate in the clinical radiology community. 3,4 The detection of child abuse is faced with numerous challenges, a major one being the absent or even misleading history given by the caretaker(s) when explaining the cause of the injury. Furthermore, very little information is known about how paediatric bones fracture under various loads, or their injury tolerance.…”

Section: Introductionmentioning

confidence: 99%

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Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study

Altai

Viceconti

et al. 2020

Clinical Radiology

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tomography (CT)-based finite element models to quantitatively investigate the likelihood of self-inflicted humeral fracture in non-ambulant infants secondary to rolling. MATERIALS AND METHODS: Three whole-body post-mortem CT examinations of children at the age of rolling (two 4-month-old and one 6-month-old) were used. The mechanical moment needed by each infant to perform a rolling manoeuvre was calculated and applied to the finite element model in order to simulate spontaneous rolling from the prone to the supine position. RESULTS: The maximum predicted strains were found to be substantially lower (with a difference of >80%) than the elastic limit of the bone. CONCLUSION: Results of this study challenge the plausibility of self-inflicted humeral fracture caused by rolling in non-ambulant infants and indicate that it is unlikely for a humeral fracture to result from this mechanism without the assistance of an external force.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study

Altai

Viceconti

et al. 2020

Clinical Radiology

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“…His major criticism is that we "completely disregarded … the force required for a bone to fail" [2]. It is true that we did not specifically address issues of force.…”

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confidence: 99%

Reply to Dr. Rosado’s letter regarding ‘Humeral fracture in non-ambulant infants — a possible accidental mechanism’

Somers

Halliday

2014

Pediatr Radiol

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Sir, I thank Dr. Rosado for his interest in our paper, "Humeral fracture in non-ambulant infants -a possible accidental mechanism" [1], the purpose of which is to provoke discussion. His major criticism is that we "completely disregarded … the force required for a bone to fail" [2]. It is true that we did not specifically address issues of force. It is also true that the question of what force is required is always asked of the expert in court proceedings. But what is the force and how do we measure it? The answer is that we simply do not know, and Dr. Rosado does not enlighten us on the subject. The referenced bio-mechanical paper by Pierce [3] states the following limitations:Concepts and the current level of understanding of fractures, of the magnitude and direction of loading required to produce specific fracture types in developing bone, is limited. This limitation of knowledge is due, in part, to the lack of experimental research that has been done in human infant specimens, and to the lack of an ideal model for investigation of bone strength and likelihood of fracture in immature bone [3].What we do know from Hymel and Jenny [4] is that it is within the power of a 3-year-old child to generate sufficient force to fracture the humerus. However, throughout our paper we emphasized that there is no proof that this mechanism is possible, and we fully appreciate the improbability and contentiousness of the proposal.This brings us to Dr. Rosado's final point, namely that we should not be swayed by the fact that the carers maintained the same story as to how the injury occurred throughout, or that the injury was solitary. The first response is that we are not swayed in so much as we do not claim that these injuries were caused accidentally. However, in our experience a characteristic of non-accidental injury is an inconsistent and changing history as the investigation proceeds. The converse may not be true, in that consistency does not equal truth. However, in each case presented it is axiomatic that either the carers are lying and the true mechanism for the fracture has not been given and is thus probably non-accidental, or the carers are telling the truth. We do not claim to know the answer and we accept that following discussion, the experience of others and emerging evidence the proposal may be proved wrong. To quote Mark Twain, "What gets us into trouble is not what we don't know.It's what we know for sure that just ain't so."

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Incorrect postulate regarding humeral fractures in non-ambulant infants

Cited by 2 publications

References 4 publications

Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study

Investigating rolling as mechanism for humeral fractures in non-ambulant infants: a preliminary finite element study

Reply to Dr. Rosado’s letter regarding ‘Humeral fracture in non-ambulant infants — a possible accidental mechanism’

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