Her father claimed he was changing her diaper and "heard a pop." 22: Spiral femur fracture in a 3 month old girl. The most common mechanism is forceful jerking or twisting of the extremity while being held near the knee or elbow.įig. Spiral fractures of the femur or humerus in non-ambulatory children.Very young infants have limited mobility and rarely would fall a sufficient distance to cause a fracture. Any fracture in an infant under age 6 months.(Note that the same general principles for distinguishing accidental from abusive bruises and burns also apply to fractures.) It is important to remember that certain fracture presentations are highly likely to be inflicted. No other findings of trauma after complete evaluation. 21: Torus ('buckle') fracture of the distal femur in a 7 month old who rolled off his parents' bed. They are most commonly seen in preschool children because their actively growing metaphyses have a lower tolerance for this type of loading.įig. Torus or buckle fractures are caused by axial loading on an extended extremity (e.g., a fall onto an outstretched arm or, in smaller children, a leg). 20: Transverse fracture of the humerus in a 5 month old. When seen in younger children, the possibility of abuse should be carefully considered.įig. Transverse fractures of long bones are usually the result of direct impacts, and thus are more common in older children after sports injuries. Note periosteal new bone formation, indication this fracture is at least 7-10 days old. 19: "Toddlers fracture" (minimally displaced spiral fracture of tibia) in a 3 year old. Accidental spiral fractures of the tibia are common in preschool children who fall short distances onto an extended leg, and are often called "toddler's fractures." Spiral fractures in very young children are highly suspicious for abuse since they are the result of forceful twisting or jerking of an extremity.įig. Spiral fractures occur when one end of an extremity is fixed (e.g., a foot is planted on the floor) but the rest of the extremity remains in motion. Like burns and bruises, certain fracture presentations are likely to be accidental, whereas others are highly likely to be inflicted.Īccidental, uncomplicated linear fractures of the parietal bone, for instance, are commonly seen in older infants and toddlers after falls from high chairs or counter tops onto hard surfaces.
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