Arkader Alexandre, Friedman Jared E, Warner William C, Wells Lawrence
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
J Pediatr Orthop. 2007 Oct-Nov;27(7):751-3. doi: 10.1097/BPO.0b013e3181558b13.
Next only to burns and bruises, fractures are the second most common sign of the physical form of child abuse. Although there is not a pathognomonic fracture pattern associated with child abuse, distal femur "corner" fractures are often considered a clue to diagnosis, particularly in children younger than 1 year old. We contend that complete metaphyseal fractures of the distal femur are a potential harbinger of child abuse in children before walking age.
This was a retrospective study performed at 2 level 1 pediatric trauma centers. Query of a trauma database in a 10-year period yielded 29 children that sustained complete metaphyseal fractures of the distal femur. Medical charts and radiographs were reviewed. Data collection included age, sex, side, mechanism of injury, associated injuries, child protective services evaluation, and primary pediatrician notes.
Of the 29 fractures, 20 occurred in children 1 year old or younger (before walking age) and formed the final studied group. The average age for the 14 boys and 6 girls was 6 months 10 days (range, 5 days to 1 year). Ten cases (50%) were confirmed to be a result of child abuse, and another 5 cases (25%) were highly suspicious for abuse. In all, 15 of the 20 children (75%) with complete distal femoral metaphyseal fractures were potentially victims of child abuse.
Based on our results, we recommend that when evaluating children before walking age with a complete distal femur metaphyseal fracture, further inquiry for possible etiology of child abuse should be performed.
Level IV--case series, diagnostic.
骨折是儿童身体虐待中仅次于烧伤和擦伤的第二常见体征。虽然没有与儿童虐待相关的特征性骨折模式，但股骨远端“角状”骨折常被视为诊断线索，尤其是在1岁以下儿童中。我们认为，股骨远端干骺端完全骨折是学步前儿童遭受虐待的一个潜在预兆。
这是一项在2家一级儿科创伤中心进行的回顾性研究。查询10年间的创伤数据库，得到29例股骨远端干骺端完全骨折的儿童。回顾了病历和X光片。数据收集包括年龄、性别、患侧、损伤机制、相关损伤、儿童保护服务评估以及儿科主治医生的记录。
在这29例骨折中，20例发生在1岁及以下（学步前）儿童中，构成最终研究组。14名男孩和6名女孩的平均年龄为6个月10天（范围为5天至1岁）。10例（50%）被确认为虐待所致，另外5例（25%）高度怀疑为虐待。20例股骨远端干骺端完全骨折的儿童中，共有15例（75%）可能是虐待受害者。
基于我们的结果，我们建议，在评估学步前患有股骨远端干骺端完全骨折的儿童时，应进一步询问可能的虐待病因。
四级——病例系列，诊断性。
