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A study of radiological features of healing in long bone fractures among infants less than a year

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Abstract

Purpose

To create a timetable for dating long bone fractures in infants aged less than 1 year using previously defined radiographic signs of fracture healing.

Materials and methods

A retrospective cross-sectional time series of long bone fractures in infants aged less than 1 year was conducted from 2006 to 2013. After exclusion criteria were applied 59 digital image series were available for review from 40 infants. Utilizing published criteria for dating fractures, the presence or absence of four pre-defined features of healing was scored: periosteal reaction, callus, bridging, and remodeling. Three radiologists independently scored radiographs with a 3-point scale, marking each feature as present, absent, or equivocal. The times in days when features were first seen, peaked (feature agreed present in >40% of images), and last seen were noted. Statistical analysis using free marginal kappa was conducted.

Results

The level of agreement among the three radiologists was high (0.64–0.85). The sequence in which the features were seen was: periosteal reaction range 7–130 (present in the majority of cases between 9 and 49 days); callus range 9–130 (present in the majority of cases between days 9–26); bridging range 15–130 (seen in the majority of cases between 15 and 67 days); remodeling range 51–247 days.

Conclusion

This study provides a timetable of radiological features of long bone healing among young infants for the first time. Dating of incomplete long bone fractures is challenging, beyond the presence of periosteal reaction, but a consistent sequence of changes is present in complete fractures.

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Acknowledgements

Elizabeth Caroll, Research Assistant.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital Colorado, Aurora, CO, USA

    Christopher Warner, Angie Miller, Jason Weinman & Michael Fadell

  2. Institute of Primary Care and Child Health, Cardiff University, Cardiff, UK

    Sabine Maguire & Laszlo Trefan

Authors
  1. Christopher Warner
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  2. Sabine Maguire
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  3. Laszlo Trefan
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  4. Angie Miller
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  5. Jason Weinman
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  6. Michael Fadell
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Corresponding author

Correspondence to Christopher Warner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article does not contain identifiable patient data.

Appendix

Appendix

Table 5 Number of agreed periosteal reactions/callus on all, complete and incomplete, fractures and total number of images over time (days)
Full size table
Table 6 The presence of bridging and remodeling of all, complete and incomplete, fractures and the total number of images over time (days)
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Warner, C., Maguire, S., Trefan, L. et al. A study of radiological features of healing in long bone fractures among infants less than a year. Skeletal Radiol 46, 333–341 (2017). https://doi.org/10.1007/s00256-016-2563-8

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  • DOI: https://doi.org/10.1007/s00256-016-2563-8

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