ABSTRACT
BACKGROUND: Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP). METHODS: Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries. RESULTS: Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types. CONCLUSIONS: This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall-related femur fractures and identifies key characteristics to facilitate decision-making.
Subject(s)
Accidental Falls , Child Abuse/diagnosis , Hip Fractures/etiology , Biomechanical Phenomena , Caregivers , Causality , Child, Preschool , Contusions/etiology , Deception , Decision Making , Diagnosis, Differential , Female , Hip Fractures/classification , Hip Fractures/epidemiology , Humans , Infant , Infant, Newborn , Male , Medical History Taking , Models, Theoretical , Multiple Trauma/epidemiology , Multiple Trauma/etiology , Parents , Prospective Studies , Ultraviolet RaysABSTRACT
INTRODUCTION: Falls are a major cause of morbidity and mortality in children, but are also reported falsely in child abuse. Therefore, it is of interest to understand those factors which may lead to a higher likelihood of injury in a feet-first freefall. METHODS: We used laboratory freefall experiments and a 3-year-old Hybrid III anthropomorphic test dummy (ATD) to assess head and femur injury risk. Wet and dry linoleum impact surfaces were used from three fall heights: 22, 35 and 47 in. RESULTS: For a given fall height, dry surfaces were associated with higher head injury criteria (HIC) values than wet surfaces. Changes in fall height 22-47 in. did not significantly affect HIC values for falls onto either surface. Generally, compressive and bending femur loading increased significantly for wet as compared to dry linoleum. CONCLUSIONS: In simulated feet first freefall experiments up to 47 in. using a 3-year-old test dummy, a low risk of contact type head injury and femur fracture was found. However, both fall height and surface conditions influenced femur loading and head injury measures. Future efforts should explore the risk of head injury associated with angular acceleration in freefalls.
Subject(s)
Accidental Falls/prevention & control , Craniocerebral Trauma/etiology , Craniocerebral Trauma/physiopathology , Femoral Fractures/etiology , Femoral Fractures/physiopathology , Models, Biological , Risk Assessment/methods , Acceleration , Altitude , Child Abuse/diagnosis , Child, Preschool , Computer Simulation , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/prevention & control , Diagnosis, Differential , Femoral Fractures/diagnosis , Femoral Fractures/prevention & control , Humans , Manikins , Physical Stimulation/adverse effects , Risk Factors , Stress, Mechanical , Surface PropertiesABSTRACT
OBJECTIVE: The objectives of our study were to assess biomechanics associated with feet-first free falls in 3-year-old children and to investigate the influence of impact surface type and fall height on key biomechanical measures associated with injury risk. METHODS: Repeatable feet-first free fall experiments were conducted in a laboratory mock-up environment using an instrumented Hybrid II 3-year-old test dummy. Impact surface type and fall height were varied to examine their influence on biomechanical measures. RESULTS: Feet-first falls from short distances (27 in.) (0.69 m) were found to have a low risk of contact-type head injury, regardless of impact surface type. When comparing different types of impact surfaces in a 27 in. (0.69 m) fall, head acceleration associated with falls onto playground foam was significantly less than that associated with falls onto wood, linoleum or padded carpet. For falls onto playground foam, femoral compressive loads and bending moments were found to significantly increase as fall height increased. CONCLUSIONS: Impact surface type and fall height were found to influence biomechanics associated with injury risk in feet-first free falls as assessed through experimental mock-ups using an instrumented child test dummy. Feet-first falls from short distances (27 in.) (0.69 m) were associated with a low risk of contact-type head injury as assessed using HIC, irrespective of impact surface type.
Subject(s)
Accidental Falls , Wounds and Injuries/etiology , Acceleration , Biomechanical Phenomena , Child Abuse/diagnosis , Child, Preschool , Craniocerebral Trauma/etiology , Craniocerebral Trauma/physiopathology , Foot , Humans , Manikins , Surface Properties , Wounds and Injuries/physiopathologyABSTRACT
BACKGROUND: Short-distance falls, such as from a bed, are often falsely reported scenarios in child abuse. In attempting to differentiate between abusive and nonabusive injury, knowledge of factors that affect injury risk in falls could prove useful. OBJECTIVES: To assess the biomechanics associated with simulated short-distance falls in children (one fall scenario, without attempting to maximize injury potential) and to investigate the effect of impact surface type on injury risk. METHODS: Repeatable fall experiments from bed height (0.68 m) onto different surfaces were conducted using an instrumented side-lying Hybrid II 3-year-old test dummy. Biomechanical measures assessed in falls included head acceleration, pelvis acceleration, femur loading, and head injury criteria. RESULTS: Fall dynamics resulted in the pelvis or legs making first contact. Biomechanical measures assessed in simulated bed falls were below known head injury criteria and lower extremity injury thresholds. The impact surface type had a significant effect on head injury risk and lower extremity loading. Playground foam proved to have the lowest associated injury risk of all the tested surfaces. CONCLUSIONS: The biomechanics of a child falling from a short distance, such as from a bed, were investigated using an experimental laboratory mock-up and an instrumented test dummy. Despite the impact surface having an effect on injury risk, rolling from a 0.68-m (27-in) horizontal surface from a side-lying posture presented low risk of contact-type head injury and leg injury on all tested impact surfaces.
