1Department of Biomedical Education and Anatomy, The Ohio State University, 2Department of Applied Forensic Sciences, Mercyhurst University, 3Department of Radiology, Nationwide Children's Hospital, 4Center for Family Safety and Healing, Nationwide Children's Hospital, 5Center for Injury Research and Policy, Nationwide Children's Hospital, 6Skeletal Biology Research Lab, School of Health and Rehabilitation Sciences, The Ohio State University
April 12, 2018 , Zilker 1/2/3
In physically abused children, skeletal fractures often go undetected and untreated for a significant time, discovered later through radiographic survey. In such cases, time since injury (TSI) may be essential for characterization of abuse. Few, if any, radiographic methods to assess TSI take into account variables that may affect healing such as fracture location, despite preliminary research suggesting differences in healing exist between upper and lower limbs. This study examines the effect of fracture location on pediatric fracture healing through radiographic analysis.
Four hundred ninety-eight skeletal fractures (>1355 radiographs) at Nationwide Children’s Hospital (Columbus, OH) were evaluated for features of fracture healing, specifically subperiosteal new bone formation (SPNBF) and callus formation. Features were recorded for presence, thickness, matrix, and character based on modified parameters set by Walters et al. (2014). Anatomical location was divided into upper limb (n=890) and lower limb (n=465). Skeletal elements included humerus (n=286), radius (n=227), ulna (n=190), clavicle (n=187), femur (n=194), tibia (n=171), and fibula (n=100). Within-bone location (excluding clavicle) was simplified into proximal (n=188), midshaft (n=799), and distal (n=349).
Independence and goodness of fit frequency tests revealed differences in callus matrix based on bone type and within-bone location, but not between upper versus lower limb. Similarly, fracture location was found to influence SPNBF thickness depending on anatomical region, element, and within-bone location. These findings suggest future methods to assess TSI may need to consider the morphology and function of each skeletal element in relation to its specific fracture patterns and potentially be bone specific.
This research was supported by the Center for Injury Research and Policy at Nationwide Children’s Hospital through Grant Number 1R49 CE002106 from the Centers for Disease Control and Prevention.