Fracture Patterns in Non-Accidentally Injured Children at the Red Cross Children's Hospital

ABSTRACT

Background: Unexplained fractures in infants and children often suggest abuse. The fracture patterns with high specificity for abuse are well documented; however; in practice these patterns occur infrequently and abused children may present with a wide spectrum of bony injuries. The Child Accident Prevention Foundation of South Africa (CAPFSA) keeps a database of children treated at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town. Methods: The medical records of all children admitted between January 1991 and October 2005 were reviewed and children with fractures resulting from non-accidental injury (NAI) were included in the study. Results: During the 14-year study period; 99586 trauma patients were treated at RXH; of which 1037 (1.04) were diagnosed with non-accidental injury. The majority was male (64). An the average age was 44.8 months. Of the 1037 patients diagnosed with NAI; 121 (11.7) sustained a total of 149 fractures; 21 (17.3) with multiple fractures (16 had 2 fractures; 3 had 3 fractures and 2 had 4 fractures). The head and neck was the most frequently fractured anatomical area (53); followed by the upper limb (24) and lower limb (18). Only 7 fractures of the trunk were seen. Children sustaining fractures of the head and neck were significantly younger than those sustaining fractures to other areas. Discussion: Although the established consensus on fracture patterns in NAI is that long bone fractures are the most frequently experienced in clinical practice; the principal finding of our study was that skull fractures were considerably more common; nearly 40of all fractures were skull fractures. Skull fractures were associated with violent injury; approximately one-third were reported to have been inflicted with an implement/weapon and one-quarter of these children had multiple fractures at the time of presentation. This underlines the importance of local studies; as socio-cultural issues underpin many of the aetiological factors related to disease burden in general; and to child abuse in particular