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Fractures associated with non-accidental injury--an orthopaedic perspective in a local regional hospital
CM Fong, HM Cheung, PY Lau
Paediatric Orthopaedic Team, Department of Orthopaedics and Traumatology, United Christian Hospital, Kwun Tong, Hong Kong
OBJECTIVES. To identify the potential risk factors
for fractures due to non-accidental injury in children, and to alert
clinicians and health care workers to the diagnosis of child abuse.
DESIGN. Retrospective review.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Children who were admitted to the hospital
with a clinical diagnosis of child abuse with associated fracture(s)
between January 1996 and April 2004.
MAIN OUTCOME MEASURES. Demographic data, site of
fractures, and investigations performed.
RESULTS. Of the 377 children presented with non-accidental
injuries, 29 (15 male, 14 female) had bone fractures. The mean age
of the 29 children at the time of injury was 5 years and 5 months.
Of the nine records showing pregnancy, seven were unplanned. Approximately
75% of the families were living in public housing estates, and 28%
were receiving social security subsidy. Over half (52%) of the abused
children were aged 3 years or less. A total of 78 fractures were
documented with a mean of 2.7 fractures per child. The most common
sites of fracture were the forearm (29%), followed by the ribs (24%).
Most long bone fractures occurred in those aged 3 years or less.
Fractures were detected by skeletal survey and bone scan for 90%
of the children.
CONCLUSION. A number of potential risk factors were
identified in children with fractures associated with non-accidental
injury. They included age younger than 3 years, lower socio-economic
status, presentation with long bone fracture, and unplanned pregnancy.
Bone scan and skeletal survey are mutually complementary, and both
should be performed in cases of suspected child abuse. Subsequent
management requires cooperation of multi-disciplinary health care
professionals.
Hong Kong Med J 2005;11:445-51
Key words: Child; Child abuse; Fractures/etiology
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