Department of Paediatrics and Child Health, Cardiff and Vale University Health Board, University Hospital of Wales, United Kingdom.
AJR Am J Roentgenol. 2012 May;198(5):1014-20. doi: 10.2214/AJR.11.6734.
Fracture dating significantly shapes decisions in child protection. With a dearth of primary evidence underpinning fracture dating in children, we examined the key radiologic features of fracture healing and their timelines.
Digital radiographs of children younger than 72 months old with accidental long bone fractures of known timing were reviewed independently by three pediatric radiologists blinded to the age of the fractures. Six radiologic features of fracture healing were evaluated: soft-tissue swelling, periosteal reaction, soft callus, hard callus, bridging, and remodeling. Interobserver agreement was assessed using kappa analysis.
Two hundred twenty-eight films of 82 fractures in 63 children (mean age, 4.8 years) were assessed. Soft-tissue swelling was identified by two or more radiologists in 59% of the radiographs at days 1-2 after fractures, and prevalence sharply declined thereafter. Periosteal reaction was first seen at day 5 and was present in 62% of the films obtained between 15 and 35 days after the fracture. Soft callus was first seen at day 12 and was prevalent in 41% between 22 and 35 days. Hard callus and bridging began at day 19, increasing to 60% prevalence from 36 days onward. Remodeling was observed only in fractures 45 days old or more. Kappa scores were between 0.55 and 0.80 overall, with greater agreement when there was no plaster cast.
The results of this study show that fractures in young children may be dated as acute (< 1 week), recent (8-35 days), or old (≥ 36 days) on the basis of the presence of six key radiologic features in combination. Furthermore, good interobserver agreement suggests these results are reproducible.
骨折发生时间对儿童保护决策具有重要影响。由于儿童骨折发生时间的主要证据不足，我们研究了骨折愈合的关键放射学特征及其时间进程。
回顾性分析了 63 例年龄小于 72 个月、已知受伤时间的意外长骨骨折患儿的数字 X 线片，3 名儿童放射科医生对骨折年龄不知情。评估了 6 种骨折愈合的放射学特征：软组织肿胀、骨膜反应、软骨痂、硬骨痂、桥接和重塑。采用 Kappa 分析评估观察者间的一致性。
共评估了 63 例患儿 82 处骨折的 228 张 X 线片（平均年龄 4.8 岁）。骨折后 1-2 天，有 59%的 X 线片可见软组织肿胀，此后其发生率迅速下降。骨膜反应最早在第 5 天出现，在骨折后 15-35 天的 X 线片中，有 62%可见骨膜反应。软骨痂最早在第 12 天出现，在骨折后 22-35 天的 X 线片中，有 41%可见软骨痂。硬骨痂和桥接在第 19 天开始出现，从第 36 天起，其发生率增加至 60%。仅在骨折 45 天或以上时才能观察到重塑。总体而言，Kappa 评分在 0.55 至 0.80 之间，当无石膏固定时，观察者间的一致性更高。
本研究结果表明，根据 6 种关键放射学特征的存在情况，可将幼儿的骨折分为急性（<1 周）、近期（8-35 天）或陈旧（≥36 天）。此外，良好的观察者间一致性表明这些结果具有可重复性。
