|
Year |
2002 |
|---|---|
|
Question Number |
246 |
|
Category |
Pediatric Orthopaedics |
Question
An 18 month infant has bilateral metaphyseal corner fractures of the distal femoral metaphyses of unknown origin. Following a skeletal survey, the next step in mangement should consist of
1) notification of child protective services
2) bilateral long leg casts and discharge
3) bilateral percutaneous pinning, long leg casts, discharge
4) Bryant’s traction
5) Modified Bryant’s traction
Figures
Answer (click for answer)
Preferred Response: 1
The answer is based upon your knowledge of the pathonemonic nature of corner fractures as indicative of child abuse. According to the cited papers, the most common abuse fractures are skull followed by long bones in disputed order, but including tibia, humerus, and femur. Corner fractures were present in 28% of child abuse cases, and were not seen in true accidental trauma. Also noted in this study was the frequency of single acute abuse fractures. 65% of abused children had one acute fracture, while only 13% had multiple injuries at varying stages of healing.
Reference: Loder RT, Fracture patterns in battered children. J Orthop Trauma 1991; 5:428-433.