Role of radiological evidences and vascular endothelial growth factor estimation in dating of fractures in children

ABSTRACT

Fractures of varying ages in young children are highly suggestive of child abuse. When suspicious circumstances are expected, one of the many factors involved in diagnosis of child abuse is the dating of fractures. The aim of this study is to determine the timing of bone fracture In children based on the evidences of radiological changes and estimated blood level of vascular endothelial growth factor [VEGF] in the context of child protection. Forty child patients with forearm fracture were obtained from outpatient clinic of orthopedic surgery department, Zagazig university hospitals during the period from 1-1-2008 to 31-12-2000. The approval from Ethical Committee of Faculty of medicine, Zagazig University and the consent from the legal responsible person of each child were obtained. The images were done initially and every two weeks till the end of the study at 12 weeks. A blood sample was taken for estimation of vascular endothelial growth factor initially [zero day] and at 2,4,6,8 10 and 12 weeks after injury. Blood sample was also taken from another forty healthy children to serve as control of VEGF level. This study showed blunting of fracture margins in all radiographs obtained two weeks after injury and thereafter. There was significant increase in periosteal reaction percentage increase at 6 weeks. Although, bone remodeling had significant increase at 8 weeks, the periosteal incorporation, increased callus density and fracture gap decrease showed significant increase at 12 weeks. The estimated level of VEGF had the maximum significant elevation at 2 weeks then showed significant decrease at 4 and 6 weeks when compared with the initial concentration. An approximate significant increase was noted at 8 and 10 weeks. At 12 weeks the level of VEGF had significant difference with that of zero day. In addition, all these VEGF levels including the initial one had significant increase when compared with control level of healthy children. Radiological data could help in estimation of the minimum and maximum time of fracture steps repair and thus provide assistance in dating. Also, estimation of vascular endothelial growth factor has an important role in timing of fracture especially during the healing phase in which the case is present and limit the observation of radiological features