Non-accidental injury, femoral shaft and neck fractures in children

Lindisfarne, E.A.O.; Ayodele, Oluwarantimi

doi:10.1016/j.mpsur.2020.06.017

Cited by 3 publications

(2 citation statements)

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“…Surprisingly, no comprehensive study has been conducted within our region over the past five years [ 2 ], leaving a crucial gap in our understanding of the dynamics and outcomes related to these fractures. This impending research undertaking seeks to bridge this knowledge gap and offer the most up-to-date insights into the prevalence of limb shortening resulting from femur shaft fractures in children treated with hip spica casting [ 3 , 4 ]. By delving into this unexplored territory, this study aspires to not only contribute vital information to our local medical community but also serve as a resource for health professionals globally.…”

Section: Introductionmentioning

confidence: 99%

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications

Kakakhel,

Rauf,

Khattak

et al. 2023

Cureus

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Introduction: Femoral shaft fractures significantly impact children and families, posing a significant challenge for pediatric patients. The prevalence of limb shortening in femur shaft fractures treated with hip spica casting in our group, however, has not been the subject of many recent investigations. Aims: By comparing the prevalence of limb shortening to various age groups and common pediatric injury patterns, this research seeks to close this information gap. Methods: This research, which lasted six months and was done at the Orthopedics Unit of Khyber Teaching Hospital Peshawar, Pakistan, included 129 children with closed femur shaft fractures who were between the ages of one and six. Clinical assessments, radiological examinations, and hip spica casting, all supervised by experienced orthopedic surgeons, were carried out. Senior postgraduate trainees oversaw the study's findings. Results: The results unveiled key insights into the study population. Among the findings, 33% (n=43) of the children were aged one to three years, while 67% (n=86) fell within the three to six years age range. Gender distribution revealed that 72% (n= 93) were male. In terms of mechanism, 22% (n=28) of fractures were attributed to road traffic accidents, 69% (n=89) were the result of falls, and 5% (n=12) were due to other causes. Notably, 19% (n=29) of the children exhibited limb shortening. Conclusion: This study contributes significantly to the understanding of femur shaft fractures in children, shedding light on their complex dynamics. The study enhances our understanding of pediatric femur shaft fractures. We found that 19% of children exhibited limb shortening, underscoring the need for targeted treatment strategies. These insights can significantly improve patient care and treatment protocols for this challenging condition, benefiting both children and their families.

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Section: Introductionmentioning

confidence: 99%

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications

Kakakhel,

Rauf,

Khattak

et al. 2023

Cureus

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“…Falls remain the major cause up to age 6, at which point pedestrians hit by vehicles becomes the major cause. For ages 13–15, fractures occur as passengers are involved in road traffic accidents [ 2 ]. Low-energy fractures are rare and are usually due to genetic, metabolic, or endocrine disorders [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review

Padgett¹,

Kothari²,

Williams³

2023

JOCR

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Introduction: Bilateral femoral diaphyseal fractures in children due to nonaccidental trauma (NAT) are a rare occurrence, with no reported cases currently published in the literature. The authors present a case of an 8-month-old male who presented with bilateral femoral shaft fractures. History, physical examination, and radiographic findings support NAT as the cause of his injuries. Due to the patient’s size and associated comorbidities, he was initially treated with Pavlik harness placement, rather than spica casting. The patient demonstrated appropriate radiographic evidence of fracture healing on follow-up. Case Report: An 8-month-old male with a complex past medical history presents to the emergency department. Per the patient’s mother, he has been demonstrating a progressive loss of movement and refusal to bear weight in his bilateral lower extremities over the preceding 1–2 weeks. Other injuries include facial bruising and lesions indicative of subconjunctival hemorrhages. After orthopedics was consulted, the decision was made to treat the patient’s bilateral femoral shaft fractures with a Pavlik harness, rather than spica casting, due to his small size and associated past medical history. The patient was subsequently discharged under foster care. Follow-up visit demonstrates appropriate fracture healing in the bilateral femoral diaphyses. Conclusion: Many cases of NAT in the pediatric population are initially missed. Orthopedic providers must maintain a high index of suspicion for NAT as many of these patients will present with musculoskeletal injuries. The authors report a rare case of NAT in a male child resulting in bilateral femoral diaphyseal fractures. The patient was successfully treated through Pavlik harness placement. Orthopedic providers should consider Pavlik harness placement as a viable option even for young children >6 months of age presenting with femoral shaft fractures if spica casting or open reduction internal fixation is not appropriate. Keywords: Femoral fracture, nonaccidental trauma, pediatric.

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Identifying Child Abuse in Patients With Femur Fractures Through Pathway Compliance: A Pilot Study

Scallon,

Wiggins,

Samson

et al. 2024

Cureus

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Background Child abuse is a significant cause of morbidity and mortality in children. A thorough history and physical exam is critical to identifying abuse. Standardized screening tools as well as clinical pathways can assist with identifying patients who may have an injury secondary to abuse. There are varied recommendations for the upper age in which to routinely evaluate pediatric patients for child abuse. Objectives The primary objective of this study was to describe the outcomes of the implementation of an evidence-based clinical pathway for suspected non-accidental trauma for all pediatric patients aged five years and under presenting with a femur fracture. This pathway includes orders for imaging, labs, and consults. In addition, the characteristics of this population and the findings were described. Methods A retrospective study of patients at a single institution who met the National Trauma Data Standard registry inclusion criteria and had a femur fracture was performed. Variables analyzed included age, demographics, mechanism and location of injury, admission status and service, injury severity, hospital characteristics, and discharge status. Patients with a metabolic bone disease were excluded. Results There were 200 patients who met the inclusion criteria. Thirty-two patients had a diagnosis of confirmed or suspected child abuse. While all 32 patients had a skeletal survey performed, only 23 (71.9%) had the complete workup per the clinical pathway, and 21 (65.6%) had a diagnosis of confirmed child abuse. Conclusion Clinical pathways are established to provide the standardization of clinical assessments and interventions; however, this process relies on a single individual to make a judgment determining whether or not to implement the pathway. Children presenting to an emergency department with confirmed or suspected child abuse are a vulnerable population. A child abuse diagnosis is a clinical judgment; however, clinical pathways aid in the diagnosis in hopes to stop any further abuse. For a pathway to be successful, each step needs to be addressed.

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Non-accidental injury, femoral shaft and neck fractures in children

Cited by 3 publications

References 48 publications

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications

Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review

Identifying Child Abuse in Patients With Femur Fractures Through Pathway Compliance: A Pilot Study

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