Jayakumar P, Barry M, Ramachandran M
The Royal London Hospital, Whitechapel, London E1 1BB, UK.
J Bone Joint Surg Br. 2010 Feb;92(2):189-95. doi: 10.1302/0301-620X.92B2.22923.
Non-accidental injury (NAI) in children includes orthopaedic trauma throughout the skeleton. Fractures with soft-tissue injuries constitute the majority of manifestations of physical abuse in children. Fracture and injury patterns vary with age and development, and NAI is intrinsically related to the mobility of the child. No fracture in isolation is pathognomonic of NAI, but specific abuse-related injuries include multiple fractures, particularly at various stages of healing, metaphyseal corner and bucket-handle fractures and fractures of ribs. Isolated or multiple rib fractures, irrespective of location, have the highest specificity for NAI. Other fractures with a high specificity for abuse include those of the scapula, lateral end of the clavicle, vertebrae and complex skull fractures. Injuries caused by NAI constitute a relatively small proportion of childhood fractures. They may be associated with significant physical and psychological morbidity, with wide- ranging effects from deviations in normal developmental progression to death. Orthopaedic surgeons must systematically assess, recognise and act on the indicators for NAI in conjunction with the paediatric multidisciplinary team.
儿童非意外性损伤（NAI）包括全身骨骼的骨科创伤。伴有软组织损伤的骨折构成了儿童身体虐待表现的大部分。骨折和损伤模式随年龄和发育而变化，并且NAI与儿童的活动能力内在相关。孤立的骨折并非NAI的特征性表现，但与虐待相关的特定损伤包括多发性骨折，特别是处于愈合不同阶段的骨折、干骺端角部骨折和桶柄状骨折以及肋骨骨折。孤立或多发性肋骨骨折，无论其位置如何，对NAI具有最高的特异性。对虐待具有高特异性的其他骨折包括肩胛骨、锁骨外侧端、椎骨和复杂颅骨骨折。NAI导致的损伤在儿童骨折中占比相对较小。它们可能与严重的身体和心理疾病相关，其影响范围广泛，从正常发育进程的偏差到死亡。骨科医生必须与儿科多学科团队一起系统地评估、识别NAI的指标并采取相应行动。
