49 research outputs found
Sternum
No full textSternum fractures in children are very rare (0.004-0.07% of all paediatric fractures) with an increasing incidence with age. Sternum fractures may result from a direct or an indirect trauma. Most cases are the result of falls or high velocity trauma mechanisms. This chapter describes the circumstances under which sternum fractures occur with emphasis on the difference between accidental and non-accidental (inflicted) injury
Scapula
No full textThe shoulder joint is composed of the scapula, clavicle, and the head of the humerus. The scapula is part of three joints: The acromioclavicular joint (acromion and clavicula), the glenohumeral joint (glenoid and proximal humerus), and the scapulothoracic joint (anterior scapula and posterior thorax) (Fig. 10.1) [1]. In this constellation, the scapula provides a stable base for movements of the humerus [2]
General Aspects of Fractures in Children
No full textA fracture is a partial or complete disruption of the continuity of bone or cartilage, due to mechanical forces exceeding the strength of the bone or cartilage to withstand these forces.Fractures are common in children. In a large Swedish study, the overall annual incidence of fractures in children was 2.1% (2.6 for boys; 1.7 for girls). Most fractures in children are the result of accidental trauma and conventional radiography (x-rays) is by far the preferred modality to diagnose them. This chapter discusses the anatomy of the bones, types of fractures and the terminology to describe fractures in an unequivocal way. In addition, fractures are discussed in the context of the trauma mechanism, the circumstances under which a fracture occurs and the age of the patient. Any discrepancies between the type of fracture and the alleged trauma mechanism (history as provided by the parents) should arise suspicion of non-accidental injury, where in general the younger the child, the greater the probability of inflicted injuries
Ribs
No full textRib fractures in paediatric patients usually result from static loading (compression) or dynamic impact loading (direct impact trauma to the ribs). In young children rib fractures are usually caused by static loading, while in mobile older children and in adolescents rib fractures are usually caused by dynamic impact loading. However, it should be noted that still there is no clear understanding of what forces and mechanisms of injury are exactly required to produce rib fractures. This is mainly because in vivo experiments in children are impossible. The information on trauma mechanism reflects what is accepted as plausible in medical science.This chapter describes the circumstances under which rib fractures occur before, during and after birth with emphasis on the difference between accidental and non-accidental (inflicted) injury.In addition, penetrating chest trauma is discussed, as well as diseases and normal variants that can simulate (healed) rib fractures
Clavicle
No full textFractures of the clavicle are amongst the most frequently diagnosed fractures, in children as well as in adults. In children it is one of the most common fractures with an estimated incidence of 5 to 15% of childhood fractures. Clavicle fractures may result from a direct or an indirect trauma. This chapter describes the circumstances under which clavicular fractures occur before, during and after birth with emphasis on the difference between accidental and non-accidental (inflicted) injury
Normal Variants, Congenital, and Acquired Disorders
No full textDiagnosing non-accidental injury is a challenging task. Missing the diagnosis may have fatal consequences for the child because no measures will be taken to prevent future injury. On the other hand, a wrongful diagnosis of non-accidental injury may have severe consequences for both caretakers as well as the child, e.g. judicial prosecution of the caretakers and placement of the child in foster care. This chapter deals with normal variants and diseases that may simulate non-accidental injury. Disease that are often mentioned in the differential diagnosis of non-accidental injury (e.g. rickets and osteogenesis imperfecta) will be discussed in more detail, whereas rare syndromes, congenital disorders and metabolic disorders, that are often reported as case reports, will be discussed in lesser detail
Pelvis
No full textPelvic fractures in paediatric and adolescent patients are uncommon, accounting for about 0.3–4% of all paediatric fractures. These fractures may indicate serious other injuries, and thus need a thorough work-up. Most pelvic fractures are the result of accidental trauma, or in case of avulsion fractures because of sports related activities. Only in very rare cases child abuse is the cause of pelvic fractures
Head
No full textHead injuries are defined as injuries to the soft tissues of the orofacial region and the scalp and/or the bony tissues of the skull (calvarium, base, and orofacial bones) and/or the intracranial contents (meninges, brain) due to mechanical or nonmechanical trauma. Most head injuries in paediatric patients are caused by mechanical trauma, irrespective whether these injuries concern soft tissues, bony tissues, or the intracranial content. Mechanical trauma may be due to static loading, dynamic impact loading or dynamic impulse loading. This chapter describes the circumstances under which head injuries occur before, during and after birth with emphasis on the differentiation between accidental and non-accidental trauma
Spine
No full textInjuries to the spine can range from relatively mild ligament and muscle strains, to fractures, dislocations, or subluxation of the vertebrae with subsequent risk of damage to the spinal cord. Fractures and dislocations of the vertebrae can occur at all levels in the spine and in all parts of a vertebra. Spinal fractures are extremely rare in children and far less common than in adult patients. Most studies on paediatric spinal injuries show a high incidence of cervical spine injury (56–100%), followed by thoracolumbar injury (1–34%). This chapter describes the circumstances under which spinal injuries occur before, during and after birth with emphasis on the differentiation between accidental and non-accidental trauma
Extremities
No full textFractures of the extremities are the most common fractures in infancy and childhood, they often occur accidentally making it sometimes difficult to discriminate them from inflicted trauma. In this chapter fractures of both the upper and lower extremity, the epidemiology, the trauma mechanisms, and the differential diagnoses are discussed. The fractures are placed in a clinical and forensic perspective
