Assuntos
Pediatria , Radiologia , Síndrome do Bebê Sacudido/diagnóstico por imagem , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Sociedades Médicas , SuéciaRESUMO
BACKGROUND: Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. OBJECTIVE: To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. MATERIALS AND METHODS: We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. RESULTS: In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. CONCLUSION: There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required.
Assuntos
Acidentes Domésticos , Maus-Tratos Infantis/diagnóstico , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , RadiografiaRESUMO
BACKGROUND: Rib fractures in children under the age of 2 years have a strong correlation with non-accidental injury (NAI). Follow-up radiographs can improve detection. OBJECTIVE: To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. MATERIALS AND METHODS: The study included all children less than 2 years of age who were investigated for suspected NAI in our institution between January 1998 and October 2003. Prior to January 2000, only selected patients were asked to attend for a follow-up chest radiograph. From January 2000 onwards all children were asked to reattend. RESULTS: Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. CONCLUSIONS: The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children.