Limb fractures and nonaccidental injury in children less than 24 months of age

Abstract

The pattern of limb fractures in children aged 24 months or younger is poorly understood. This age group is particularly vulnerable to nonaccidental injury, which can be difficult for inexperienced clinicians to detect. The aim of this study is to identify fracture patterns in children below the age of 24 months. Data was collected prospectively. For all fractures, the mechanism of injury including height of fall (cm), severity of injury, outcome and deprivation scores were collected. Information on children referred for child-protection review was also noted. During the 12 months of the year 2003, 122 new patients aged less than 24 months presented with limb fractures directly to the Emergency Department of the Royal Hospital for Sick Children, giving an incidence of 4.55 per 1000 in the 0-12-month group and 17 per 1000 in the 13-24-month group. Sixty-three (52%) children sustained the injury during a fall and only 7% of children were admitted, the rest being followed up as outpatients. Thirty-eight (31%) had simple distal radius/ulna fractures. Five children with unclear histories or mechanisms of injury underwent formal child-protection procedures. All were less than 14 months of age. Fractures are relatively rare in the first 2 years of life. Child protection needs to be considered in all children, but specifically in those patients with atypical fractures presenting with an unclear mechanism of injury.