Understanding forearm fractures in young children: Abuse or not abuse?

Ryznar, Elizabeth; Rosado, Norell; Flaherty, Emalee G.

doi:10.1016/j.chiabu.2015.02.008

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…This finding is in accordance with a previous study that showed that no particular type of forearm fracture was specific for abuse in children younger than 18 months [9]. However, while not addressing the parry fracture specifically, transverse fractures were seen in 45% (5/11) of the abusive fractures, compared to 28% (9/32) of non-inflicted fractures [9].…”

Section: Discussionsupporting

confidence: 92%

“…This study had several limitations. In contrast to a previous study [9], the basis of our study was a specific type of forearm fracture. As it turned out, our sample did not include any cases where actual abuse was identified; none of the patients had been referred to a child protective team for further evaluations.…”

Section: Discussionmentioning

confidence: 86%

“…Even though the isolated ulnar shaft fracture is an uncommon fracture type (4% of the forearm fractures in children) [9], the current sample of 36 patients is perhaps still too small to identify associations between type of fracture and possible child abuse. A larger patient population would be desirable.…”

Section: Discussionmentioning

confidence: 90%

“…In an older child, forearm fractures most often occur from falling onto an arm that is outstretched to break the fall [3]. In a retrospective study on 47 children (2-17 years old) with a forearm fracture that had been screened by a child protective team, no particular type of forearm fracture was inherently indicative of child abuse [9]. No specific type of fracture, on its own, can distinguish an abusive from a nonabusive cause [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

et al. 2021

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A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

et al. 2021

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“…Comprehensive study of these characteristics across all injury mechanisms, type of injury, and body region, are rarely included in epidemiologic studies of childhood injury. Body region and type of injury characteristics have not been included in more comprehensive examinations of injury, but do appear in studies of specific mechanisms of injury, such as abusive injuries or falls (Leventhal et al, 2010; Ryznar et al, 2015; Wang et al, 2013; Zielinski et al, 2012). Abusive traumatic head injury has been studied extensively through hospitalization data.…”

Section: Introductionmentioning

confidence: 99%

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

et al. 2020

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Hospitalization data provide context to understanding abusive and non-abusive injuries and how these hospitalizations change over time. The purpose of this study was to utilize Texas inpatient hospitalization data to assess age-related differences among infants (<12 months of age) and toddlers (12–59 months of age) in injury trends and patterns of injury among abusive and non-abusive hospitalization encounters over a 15-year time period. For both age groups, pediatric hospitalizations for non-abusive injuries decreased significantly over time; however, hospitalizations for abusive injuries did not. Compared to non-abusive injury hospitalizations, abusive injury hospitalizations were statistically more likely to involve more body regions and were associated with fractures, internal organ injuries, and superficial wounds. Abusive injury hospitalizations had longer lengths of stay and resulted in higher illness severity scores. Toddler injury hospitalizations were associated with most of the body regions, with the exception of traumatic brain injury for which the odds of hospitalization were higher for infants. This study confirms the persistence of abusive injury hospitalizations and the age-related susceptibility to certain injuries comparing infants and toddlers. The findings reflect the clinical documentation and decision making of pediatric practitioners in a large state over 15 years and inform the trends in identification of injuries which are most common and consistent by age and intent.

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Fractures and Skeletal Injuries

Bachim¹,

Harper²

2018

A Practical Guide to the Evaluation of Child Physical Abuse and Neglect

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Understanding forearm fractures in young children: Abuse or not abuse?

Cited by 9 publications

References 28 publications

Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

Trends in Abusive and Nonabusive Injury Hospitalizations in Young Children in Texas, 2004–2018

Fractures and Skeletal Injuries

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