Abstract
Introduction: Skull, rib, corner fractures, and fractures in children who have not started walking are highly associated with abuse. The majority of fractures stemming from abuse occur in children less than two years of age. The purpose of this study is to determine the etiology and relationship of displaced supracondylar elbow fractures with child abuse.
Materials and Methods: Seventy-five displaced supracondylar elbow fractures were reviewed to determine how the injury occurred. Medical records and radiographs were analyzed for demographics, cause of injury, age of injury, injury data, and for the presence of a child abuse investigation. Transphyseal fractures were excluded.
Results: Forty-two males (56%) and 33 females (44%) were studied. The average age was 6 years old (range: 1-year-5-months to 12-years-4-months). Two patients were 12 years of age, 3 were 23 years of age, and 70 were older than 3. All 75 were displaced supracondylar fractures. One fracture was open. All fractures stemmed from a reported accidental fall, including: falls from- -playground equipment 29 (39%), furniture 10 (13%), sports 6 (8%), stairs 3 (4%), bikes 3 (4%), and miscellaneous: running, falling, sledding, tree, wagon, fence, bounce-house, van, deck, power-wheels car, ATV, and go-cart. Outside physicians, orthopaedic surgeons, emergency department physicians, residents, nurses, and technicians evaluated each patient. All of them are able to submit for an evaluation if they suspect abuse. Only 1 patient aged 1-year-5-months, injured from a reported fall at home during a tantrum, was reported for possible abuse. The child abuse evaluation was negative.
Discussion and Conclusion: Pediatric supracondylar fractures occur from accidental falls while children are at play. Most supracondylar fractures occur in children over the age of two. In the current series, 73 out of the 75 cases involved individuals that were two years of age or older. Child abuse is rarely associated with displaced supracondylar fractures in children.
Keywords
Pediatric Orthopaedics, Supracondylar, Abuse, Upper Extremity Trauma