Tibial fractures in very young children and child abuse
Date First Published:
April 21, 2006
Last Updated:
April 21, 2006
Report by:
Rob Williams, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
N Hardcastle, Manchester Royal Infirmary
Three-Part Question:
In [very young children who present with tibial fractures] what are [the relative chances] of [accidental and non-accidental injury]?
Clinical Scenario:
An 18 month old child attends the department with a limp. You question the mother of the child who explains that the child has fallen down three stairs at home. X-ray reveals a transverse tibial fracture. Further inquiry is unrewarding, and you wonder whether the prescence of the fracture alone is sufficient to support a diagnosis of non-accidental injury.
Search Strategy:
EMBASE <1980 to 2006 Week 12
Ovid MEDLINE(R) <1966 to March Week 3 2006
The Cochrane Library 2006, Issue 1
Ovid MEDLINE(R) <1966 to March Week 3 2006
The Cochrane Library 2006, Issue 1
Search Details:
Embase/Medline:(exp battered child syndrome OR battered child syndrome.mp OR child abuse OR non-accidental injury.mp OR non-accidental trauma.mp) AND (exp tibial fractures OR transverse tibial fracture$.mp OR spiral tibial fracture$.mp) LIMIT to human AND English.
Cochrane:[Child abuse [MeSH] ] AND [tibial fractures [MeSH]] – 0 results
Cochrane:[Child abuse [MeSH] ] AND [tibial fractures [MeSH]] – 0 results
Outcome:
44 papers were found of which 3 were of some relevance to the question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Spiral tibial fractures of children: a commonly accidental spiral long bone fracture. Mellick LB. Reesor K. 1990, USA | 10 children aged less than 4 years with isolated spiral tibial fractures | Case series | Number of non accidental injuries | 1 (10%) | Small series subject to inclusion bias |
| Fractures in children younger than age 1 year: Importance of collaboration with child protection services. Banaszkiewicz PA. Scotland TR. Myerscough EJ. 2002, UK | 5 children aged less than I year with tibial fractures | Retrospective survey | Definite abuse | 1 (20%) | Very small number of tibial fractures in the study Retrospective assessment of abuse risk |
| Likely abuse | 1 (20%) | ||||
| Suspicious of abuse | 1 (20%) | ||||
| The risk of child abuse in infants and toddlers with lower extremity injuries. Coffey C. Haley K. Hayes J. Groner JI. 2005, USA | 26 children aged 18 months or less with tibial fractures | Retrospective survey | Abuse | 25 (96%) | Small number of cases from a large survey |
Author Commentary:
The numbers of children with the target condition (tibial fracture) in the case series is small. However in the cases found there seems to be a clear link between tibial fractures in very young children (aged 18 months or less) and non-accidental injury.
Bottom Line:
Very young children with tibial fractures should be closely assessed for non-accidental injury
References:
- Mellick LB. Reesor K.. Spiral tibial fractures of children: a commonly accidental spiral long bone fracture.
- Banaszkiewicz PA. Scotland TR. Myerscough EJ.. Fractures in children younger than age 1 year: Importance of collaboration with child protection services.
- Coffey C. Haley K. Hayes J. Groner JI.. The risk of child abuse in infants and toddlers with lower extremity injuries.