Haney Suzanne B, Boos Stephen C, Kutz Timothy J, Starling Suzanne P
Eastern Virginia Medical School, Norfolk, VA, USA.
Pediatr Emerg Care. 2009 Dec;25(12):841-4. doi: 10.1097/PEC.0b013e3181c330f0.
This study describes the mechanism of injury of an impacted transverse fracture of the distal femoral metadiaphysis. Individual experience by child abuse pediatricians with this fracture type has suggested that it is less associated with inflicted trauma than was described in a prior case series.
Case contributions were solicited from an international group of child abuse clinicians. Eighteen cases were accepted for analysis. Cases were categorized as abuse or nonabuse by a predefined categorization scheme. Differences in the 2 groups were analyzed by Fischer exact test.
Thirteen cases (72%) were determined to be nonabusive, and 5 (28%) were determined to be from abuse. Additional skeletal injuries on skeletal radiograph survey, absence of any explanatory history, and significant changes in repeated histories identified cases of abuse. A short fall was accepted as the explanation for the nonabuse cases, with some indication that direct impact on the knee explained the injury.
Impacted transverse fracture of the distal femoral metadiaphysis may occur as a result of an accidental short fall of young children. A traditional abuse evaluation should be pursued in these cases, but with an absence of additional skeletal findings, and a history of a fall, it is likely that an accidental mechanism accounts for the injury.
本研究描述了股骨远端干骺端嵌插横行骨折的损伤机制。儿童虐待问题儿科医生对这种骨折类型的个人经验表明，与之前病例系列中所描述的相比，其与受虐创伤的关联较小。
向一个国际儿童虐待临床医生小组征集病例资料。共接受了18例病例进行分析。根据预先定义的分类方案将病例分为虐待或非虐待两类。两组之间的差异采用Fisher精确检验进行分析。
13例（72%）被判定为非虐待性骨折，5例（28%）被判定为受虐所致。骨骼X线检查发现的其他骨骼损伤、无任何可解释的病史以及多次病史中的显著变化可确定为受虐病例。非虐待病例被认为是因意外短距离摔倒所致，有迹象表明对膝盖的直接撞击可解释损伤原因。
股骨远端干骺端嵌插横行骨折可能是幼儿意外短距离摔倒的结果。在这些病例中应进行传统的虐待评估，但如果没有其他骨骼检查结果且有摔倒史，则损伤很可能是由意外机制造成的。
