Pattern of Fractures in Non-Accidental Injuries in the Pediatric Population in Singapore

Abstract

BackgroundFractures as a result of non-accidental injuries (NAI) are not uncommon among children. The purpose of our study was to describe the incidence, demographic characteristics, and associated risk factors in patients with NAI in a multiethnic Asian cohort.MethodsA retrospective record review of patients admitted to our hospital between September 2007 and 2009 with the diagnosis of NAI was conducted.ResultsA total of 978 children were reported with suspicion of NAI. Among them, 570 patients (58.28%) were diagnosed with NAI. Fractures were observed in 35 children (6.14%). NAI fractures were highest among female infants (73.3%). The biological father was the most common known perpetrator of NAI (n = 155, 29.0%). The most common perpetrator sadly remained unknown (n = 14, 40%). All NAI fractures were closed (n = 35, 6.14%), and the most commonly affected bone was the humeral shaft (n = 10, 28.57%) with an oblique configuration. Age < 1 year and parental divorce were significant risk factors associated with these fractures.ConclusionsThe skeletal injury pattern and risk factors highlighted in our study will help treating physicians identify patients susceptible to NAI, as many of these patients are young and vulnerable. Protective measures can be initiated early by recognizing these injuries and preventing further physical and psychological harm to the child.

Predictors for Nonaccidental Trauma in a Child With a Fracture—A National Inpatient Database Study

“…The prevalence of specific fracture sites associated with NAT varies greatly throughout the literature, primarily in regard to all fractures versus fracture patterns treated by orthopaedic surgeons (ie, extremity, vertebral, and pelvic fractures). 7,10,11,[14][15][16] Our fracture site prevalence among children with child abuse closely approximates the distribution reported by Gera et al and Valvano et al 7,16 We noted that the mortality rates doubled when the fracture had been identified as a result of NAT. Upper limb fractures demonstrated the greatest association with the risk of death when the hospital admission had also been coded for child abuse (OR = 6.3, P , 0.0001).…”

“…Whether performing a consultation in the emergency department or an inpatient setting, orthopaedic surgeons are trained to recognize certain fracture patterns as indicators of NAT; however, the association of these indicators has not been well quantified for clinical use. [7][8][9][10][11] The Kids' Inpatient Database (KID) is part of a larger collection of databases organized and funded by the Agency for Healthcare Research and Quality. 12 It is a unique allpayer database that collects comprehensive information on pediatric (age , 21 years) hospital admissions on a national scale.…”

Social, clinical and radiological characteristics of physical abuse of children up to 3 years of age hospitalized in a tertiary health institution

“…Our results indicate that physical abuse of children younger than three years was undoubtedly confirmed in only 5% of 98 suspected cases. This is relatively low compared to other reports because there was no consistent approach to the investigation of these children [15][16][17][18][19].…”

“…Large studies cite unknown or inconsistent history of mechanism of injury as a major indicator of abuse [1,2,3,[15][16][17][18][19][20]. In most of our cases, the mechanism of injury was either unknown or it was stated to be self-injury.…”

“…The third major indicator of child abuse is the presence of visible soft tissue injuries (bruises, abrasions, lacerations), especially if they are present in several regions of the body in non-ambulant children or over non-bony sites (i. e. cheeks, buttocks or thighs), if they vary by date or have typical appearance suggestive for abuse (handprint, pinch, and tramline bruises, cord or belt buckle marks, bites) [1,2,3,5,[15][16][17][18][19][20]. Upper lip frenulum tear and ear contusions are highly suggestive for child abuse.…”