Archive Copy: - 1999 Annual Meeting Scientific Program. Femoral Fractures in Children and Adolescents: Consensus and Controversy
Moderator(s): James H. Beaty, MD, Memphis, TN Monday, February 8, 1999 SYMPOSIUM
James R Kasser, MD, Boston, MA Scott J Mubarak, MD, San Diego, CA Charles Turner Price, MD, Orlando, FL William W Robertson Jr, MD, Washington, DC John F Sarwark, MD, Chicago, IL
Femoral shaft fractures are relatively common injuries in children and adolescents. In children 6 to 10 years of age and in older adolescents, treatment indications for isolated femoral shaft fractures often overlap. Spica casting, external fixation, flexible intramedullary nailing, locked intramedullary nailing, and compression plating all have been recommended in various age groups, making treatment decisions difficult. Faculty with experience in each type of treatment will discuss indications and contraindications, advantages and disadvantages, technique pearls and pitfalls, outcome, complications, and cost analysis of the various methods. Emphasis will be on choosing the most appropriate treatment method for each individual patient.

POSNA Core Curriculum

Robert Shapiro Cincinnati Children's Hospital Medical Center

Diagnosing physical child abuse: the way forward M A Barber, J R Sibert Department of Child Health, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX, UK Accepted 22 March 2000 In this article, we will review the evidence we have on the diagnosis of physical abuse in children. We will also review the differential diagnosis, the process of differentiation of physical abuse from accident, and what basis we have for giving evidence to the child protection process.

POLICY STATEMENT PEDIATRICS Vol. 105 No. 6 June 2000, pp. 1345-1348 AMERICAN ACADEMY OF PEDIATRICS: Diagnostic Imaging of Child Abuse Section on Radiology ABSTRACT The role of imaging in cases of child abuse is to identify the extent of physical injury when abuse occurs, as well as to elucidate all imaging findings that point to alternative diagnoses. Diagnostic imaging of child abuse is based on both advances in imaging technology, as well as a better understanding of the subject based on scientific data obtained during the past 10 years.1-3 The initial recommendation was published in Pediatrics (1991;87:262-264). The concept of child abuse as a medical entity has its origin in the studies of the pediatric radiologist, John Caffey, MD,4 as well as many other specialists in the field of diagnostic imaging. Kempe5 relied heavily on the work of Caffey and his protégé, Frederick Silverman, MD,6 when developing the familiar concept of the "battered child syndrome." When all cases of child abuse and neglect are studied, the incidence of physical evidence documented by diagnostic imaging studies is relatively small. However, imaging studies are often critical in the assessment of infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen with an apparent natural illness. When viewed in conjunction with clinical and laboratory studies, imaging findings commonly provide support for allegations of abuse.7 For severely abused infants, the imaging findings alone may form the basis for a diagnosis of the inflicted injury. The role of imaging in cases of suspected abuse is not only to identify the extent of physical injury when abuse has occurred, but also to elucidate all imaging findings that point to alternative diagnoses.8,9 As most conventional imaging studies performed in these settings are noninvasive and entail minimal radiation risks,10 recommendations about imaging should focus on examinations that provide the highest diagnostic yield at acceptable cost.11

Femoral neck fractures in the young adult are a different type of fracture than those seen in the elderly. These younger patients have normal bone density. A simple fall is not going to break the femoral neck. These fractures require high energy type injury mechanisms, and greater than 50% of the patients will have associated injuries as a reflection of the severity of their injury. The mechanisms is usually an axial load to the lower extremity with an abducted hip. The fracture pattern in these patients tends to be more vertical than in the elderly patient. Expert

Femoral shaft fractures in children are a little difficult to deal with, especially if you are taking care of them sporadically and especially when they are associated with polytrauma. Expert

Non Accidental Injury (Battered Baby Syndrome) Also known as: Ambroise Tardieu's syndrome Caffey's syndrome II Caffey-Kempe syndrome Silverman syndrome Definition The clinical presentation of child abuse: various injuries to the skeleton, soft tissues, or organs of a child sustained as a result of repeated mistreatment or beating, usually by an individual responsible for its care. Radiographic Appearance

Orthopaedic Trauma Association Powerpoint Presentation Residents' Slide Collections

Wheeless Testbook of Orthopaedics - Discussion: - child abuse occurs most often under the age of 3 years; - when child abuse goes unrecognized, the mortality rate may be as high as 5 %; - differential dx: - osteogenesis imperfecta - note that w/ some OI phenotypes, radiographic osteopenia may be slight and may be missed on x-ray; - in these cases, consider dual energy x-ray absorptiometry; - references: - The role of dual energy x-ray absorptiometry in aiding the diagnosis of pediatric osteogenesis imperfecta. MS Moore. et al. American Journal of Orthopaedics. Dec 1998. p 797. - Common Fractures: - rib fractures: the most commonly found fractures in child abuse (followed by humerus, femur, and tibia); - femur fracture: the majority of femur frxs in infants are due to abuse;

Also discusses whether to remove flexible nails from a patient with Osteogenesis Imperfecta

Diagnostic Radiology John Anderson UCSF

Fracture pattern of accidental aetiology but commonly mistaken for abuse

Discussion on OTA list

Acute Musculoskeletal Injuries