![]() 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. ![]() 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 2, – 4 Physical abuse may not be considered in the physician’s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 10.1542/peds.2013-3793įractures are the second most common injury caused by child physical abuse bruises are the most common injury. Esposito Evaluating Children With Fractures for Child Physical Abuse. Mehollin-Ray, Maria-Gisela Mercado-Deane, Sarah Sarvis Milla, Irene N. Lukefahr, Robert D Sege, Christopher I. Hennrikus, and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON CHILD ABUSE AND NEGLECT, SECTION ON RADIOLOGY, SECTION ON ENDOCRINOLOGY, SECTION ON ORTHOPAEDICS, the SOCIETY FOR PEDIATRIC RADIOLOGY, Cindy W. Īngular remodeling of midshaft forearm fractures in children. charnley noted that recurrent angulation is esp common in radial green stick frx with an intact ulna ĭorsally angulated solitary metaphyseal greenstick fractures in the distal radius: results after immobilization in pronated, neutral, and supinated position. recurrent angulation is more likely w/ volar rather than dorsal recurrent deformity w/in cast is number one problem w/ green stick frx ![]() in these green stick frxs, if the cortex is not completely broken thru, increasing deformity may occur even minimally angulated greenstick frx can angulate more in a cast so consider reduction if anguation exceeds 10 deg or more long arm cast is applied for a period of 4 to 6 weeks long arm cast is applied after forearm gently rotated into supination following reduction, need 3 Point Molding to keep tension on intact periosteal hinge. during manipulation, deformity is reversed, so that the distal frag is angulated toward volar aspect until intact dorsal cortex is fractured a volarly angulated greenstick frx is manipulated w/ forearm in pronation while a dorsally angulated frx is manipulated w/ forearm in supination there is no need to attempt correction for angulation measuring < 10 deg in children less than 10 yrs of age up to 15 deg may be accepted depending on age of patient consider reduction w/ completion of frx by reversal of deformity if angulation > 25-30 deg these do not require reduction if dorsal angulation is insignificant overcorrection of fracture may be required (completing the fracture) green stick frxs of mid 1/3 of radius & ulna: w/ "isolated" ulnar shaft green stick frx, always check for radial head tenderness, which would indicate a Monteggia frx eqivalent, in which there has been spontaneous reduction of the radial head when only 1 bone of forearm is broken, integrity of the proximal & & distal radioulnar joints needs to be evaluated volar fracture sustained with forearm in supination dorsal fracture sustained with forearm in pronation may be dorsal, volar, or toward or away from interosseous membrane note that the normal ulna should have a completely straight posterior border on the lateral radiograph incomplete long bone frx, w/ failure of cortex on tension side (convex side of angulation) w/ plastic deformation of cortex on concave side frx may be incomplete (greenstick) in radius and/or ulna, or the frx may be complete in one bone and incomplete (green stick) in the other Green Stick Frxs of Mid 1/3 of Radius & Ulna
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