Abstract
Background
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position.
Objective
To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party.
Materials and methods
We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present.
Results
In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party.
Conclusion
There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required.
Similar content being viewed by others
References
Hymel KP, Jenny C (1996) Abusive spiral fracture of the humerus: a videotaped exception. Arch Pediatr Adolesc Med 150:226–228
Kleinman PK (1998) Diagnostic imaging of child abuse, 2nd edn. Mosby, St. Louis
Karmazyn B, Lewis ME, Jennings SG et al (2011) The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol 197:159–163
Worlock P, Stower M, Barbor P (1986) Patterns of fractures in accidental and non-accidental injury in children: a comparative study. Br Med J 293:100
Pandya NK, Baldwin KD, Wolfgruber H et al (2010) Humerus fractures in the pediatric population: an algorithm to identify abuse. J Pediatr Orthop B 19:535–541
Taitz J, Moran K, O’Meara M (2004) Long bone fractures in children under 3 years of age: is abuse being missed in emergency department presentation? J Paediatr Child Health 40:170–174
Joffe M, Ludwig S (1988) Stairway injuries in children. Pediatrics 82:457–461
Docherty E, Hassan A, Burke D (2010) Things that go bump … bump … bump: an analysis of injuries from falling down stairs in children based at Sheffield Children’s Hospital. Emerg Med J 27:207–208
King J, Diefendorf D, Apthorp J et al (1988) Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 8:585–589
Thomas S, Rosenfield NS, Leventhal JM et al (1991) Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics 88:471–476
Kogutt MS, Swischuk LE, Fagan CJ (1974) Patterns of injury and significance of uncommon fractures in the battered child syndrome. AJR Am J Roentgenol 121:143–149
Carty H (1993) Fractures caused by child abuse. J Bone Joint Surg (Br) 75:849–857
Strait RT, Siegel RM, Shapiro RA (1995) Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse? Pediatrics 96:667–671
Nimityongskul P, Anderson LD (1987) The likelihood of injuries when children fall out of bed. J Pediatr Orthop 7:184–186
Kravitz H, Driessen G, Gomberg R et al (1969) Accidental falls from elevated surfaces in infants from birth to one year of age. Pediatrics 44:869–876
Lyons T, Oates R (1993) Falling out of bed: a relatively benign occurrence. Pediatrics 92:125–127
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Somers, J.M., Halliday, K.E. & Chapman, S. Humeral fracture in non-ambulant infants—a possible accidental mechanism. Pediatr Radiol 44, 1219–1223 (2014). https://doi.org/10.1007/s00247-014-2954-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-014-2954-8