Mechanical properties of infant bone

Ambrose, Catherine G.; Martinez, Miriam E. Soto; Bi, Xiaohong; Deaver, Juanita; Kuzawa, Cole; Schwartz, Lindsey M; Dawson, Brian; Bachim, Angela; Polak, Urszula; Lee, Brendan; Crowder, Christian

doi:10.1016/j.bone.2018.05.015

Cited by 21 publications

(17 citation statements)

References 21 publications

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“…Outcome measures were fracture of the skull, long bone, clavicle and the ribs with or without transport accidents, or fall accidents. These were categorized by age younger or older than 6 months according to the understanding of bone development during infancy [8, 9], and fracture risk in association with prematurity [11].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study

Högberg¹,

Andersson²,

Högberg³

et al. 2018

PLoS ONE

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BackgroundThe aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis.MethodsThe design was a population-based register study in Sweden. Participants: Children born 1997–2014, 0–1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register. Main outcome measures were fractures of the skull, long bone, clavicle and ribs, categorized by age (younger or older than 6 months), and accident or not.FindingsThe incidence of fractures during infancy was 251 per 100 000 infants (n = 4663). Major fracture localisations were long bone (44·9%), skull (31·7%), and clavicle (18·6%), while rib fractures were few (1·4%). Fall accidents were reported among 71·4%. One-third occurred during the first 6 months. Metabolic bone disease risk factors, such as maternal obesity, preterm birth, vitamin D deficiency, rickets, and calcium metabolic disturbances, had increased odds of fractures of long bones and ribs in early infancy (0–6 months): birth 32–36 weeks and long bone fracture [AOR 2·13 (95%CI 1·67–2·93)] and rib fracture [AOR 4·24 (95%CI 1·40–12·8)]. Diagnosis of vitamin D deficiency/rickets/disorders of calcium metabolism had increased odds of long bone fracture [AOR 49·5 (95%CI 18·3–134)] and rib fracture [AOR 617 (95%CI 162–2506)]. Fractures without a reported accident had higher odds of metabolic risk factors than those with reported accidents. Abuse diagnosis was registered in 105 infants, with overrepresentation of preterm births, multiple births and small-for-gestational age.InterpretationMetabolic bone disease risk factors are strongly associated with fractures of long bone and ribs in early infancy. Fracture cases with abuse diagnosis had a metabolic bone risk factor profile.

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Section: Methodsmentioning

confidence: 99%

“…Bone strength and stiffness is lower during infancy, being lowest around 4–5 months, compared to adolescents and adults [8]. During the first six months of life, density of the long bones decreases by 30%, in what is called “the physiological osteoporosis of infancy”, however, this is not accompanied by increased bone fragility [9].…”

Section: Introductionmentioning

confidence: 99%

Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study

Högberg¹,

Andersson²,

Högberg³

et al. 2018

PLoS ONE

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“…Young children (< 12 months) have less strong and stiff bones than older children, but their bones are much more flexible compared to older children. The strength and stiffness increases with age, as demonstrated by Ambrose et al [14]. This suggests that infants are more protected from getting fractured by external force than adolescents.…”

Section: Demographic Characteristicsmentioning

confidence: 78%

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

et al. 2020

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Purpose The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT. Methods Skeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected. Results A total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11-48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected. Conclusion Occult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture. Keywords Non accidental injury • Paediatric injury • Fractures and dislocations • x-ray • Skeletal survey Abbreviations NAT Non-accidental trauma AHT Abusive head trauma MCF Metaphyseal corner fractures CAN, Child abuse and neglect team

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“…have described the study sample and preliminary results . Some of the mechanical testing data are reported by Ambrose, Martinez .…”

Section: The Infant Injury Database (Iid)mentioning

confidence: 99%

“…These data are currently being analyzed for future publication; Soto Martinez et al have described the study sample and preliminary results (39,40). Some of the mechanical testing data are reported by Ambrose, Martinez (41).…”

Section: The Infant Injury Database (Iid)mentioning

confidence: 99%

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

Martinez

Love

Pinto

et al. 2019

Journal of Forensic Sciences

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In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence‐based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma‐related and nontrauma‐related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).

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Mechanical properties of infant bone

Cited by 21 publications

References 21 publications

Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study

Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

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