Characterization of Fractures in Pre- and Early Ambulatory Children

Introduction Fractures are a commonly encountered injury in children. Etiologies of fractures may vary in childhood including trauma, inflicted injuries, and predisposing medical conditions. It is imperative that diagnoses such as non-accidental trauma or genetic conditions which can predispose children to fractures are identified early. Though standardized workflows have been developed at many medical centers to identify these etiologies in children, complete workup is not always available at time of presentation, and diagnoses may become clearer as more information is gathered. Thus, the purpose of this study is to describe the etiology of fractures in children less than 18 months of age, with a specific emphasis placed on how the initial determination of fracture etiology compares with that resulting from retrospective review by a multidisciplinary team. Materials and Methods This retrospective-cross sectional study utilized a multidisciplinary team to evaluate the etiology of fractures in children aged 18 months or younger. Initial etiology determined at time of presentation was compared to the multidisciplinary team’s retrospective determination of etiology. Statistical analysis was performed. Results A total of 746 patients met inclusion criteria. The etiology of most fractures was ultimately determined to be accidental (n=699), 39 were determined to be inflicted, and 8 were due to genetic/predisposing factors. Overall, 75% of fractures (559/746) maintained the same etiology both on initial evaluation and following retrospective review by the fracture work group. Discussion Trauma is the most common etiology of fractures in children under 18 months of age, followed by inflicted trauma and genetic/predisposing factors. While a multidisciplinary team deemed many fractures to be consistent with initial estimate of etiology, a substantial proportion (25%) of patients were determined to have etiologies of fractures that differed from initial diagnosis, emphasizing the necessity of close follow up for children with fractures. Level of Evidence Level IV Key Concepts • Most fractures in children 18 months or younger are due to trauma • 25% of fracture etiologies differed from initial determination • Close follow up may be required to identify inflicted and genetic etiologies