The 89th Annual Meeting of the American Association of Physical Anthropologists (2020)

Fracture Healing in Unintentional and Abuse-Related Fractures in Children: Considerations of Identity in the Context of Physical Abuse


1Division of Anatomy, The Ohio State University, 2SNA International, In support of DPAA Hawaii, 3Department of Radiology, Nationwide Children's Hospital, 4Center for Family Safety and Healing, Nationwide Children's Hospital, 5Center for Pediatric Trauma Research & Center for Injury Research and Policy, Nationwide Children's Hospital, 6Skeletal Biology Research Lab, School of Health and Rehabilitation Sciences, The Ohio State University

April 16, 2020 , Diamond 7 Add to calendar

Untreated healing fractures in physically abused children may be discovered during radiographic survey and accurate time since injury estimation can be essential for identification and characterization of abuse. Timelines of fracture repair are primarily derived from unintentional fractures in otherwise healthy children and applied to children suffering physical abuse and other forms of maltreatment. However, potential differences in healing between abuse-related and unintentional fractures has been largely unexplored. This study provides a preliminary evaluation of the relationship of abuse status to fracture healing through a retrospective analysis of radiographically visible features of fracture healing in a modern pediatric population. In total, 176 radiographic follow-ups from 56 patients with humeral fractures (abuse-related: 19, unintentional: 37) were assessed in patients under the age of two years. Subperiosteal new bone and callus formation were assessed radiographically using modified parameters based on Walters et al. (2014). Kruskal-Wallis H tests were performed to determine if there were significant differences in fracture healing time between abuse-related and unintentional fractures. Over half the abuse-related fractures were associated with multiple fractures. Subperiosteal new bone formation was observed earlier in abuse-related fractures, but this was not statistically significant (p=0.310). All levels of callus matrix occurred earlier in abuse-related, but only one level reached statistical significance. Intermediate callus occurred approximately 7 days earlier in abuse-related fractures (p=0.057) than unintentional fractures. These results suggest that there may be differences in healing between abuse-related and unintentional fractures and that the context of abuse should be considered when applying fracture healing timelines

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. 

Slides/Poster (pdf)