Multicentre study of physical abuse and limb fractures in young children in the East Anglia Region, UK.

OBJECTIVE: To determine if the detection of physical abuse in young children with fractures is of uniform high standard in the East Anglia Region of the UK, and whether we can identify areas for improvement in our detection of high-risk groups. DESIGN: Multicentre retrospective 4-year study. SETTING: 7 hospitals across the East Anglia Region of Britain (East Anglia Paediatric Physical Abuse and Fractures study). PARTICIPANTS: Age groups and fractures indicated as being at higher risk for physical abuse (all children under 12 months of age, and fractures of humerus and femur in children under 36 months of age). OUTCOME MEASURES: Our criterion for physical abuse was the decision of a multiagency child protection case conference (CPCC). RESULTS: Probability of CPCC decision of physical abuse was highest in infants, ranging from 50% of fractures sustained in the first month of life (excluding obstetric injuries) to 10% at 12 months of age. Only 46%-86% of infants (under 12 months) with a fracture were assessed by a paediatrician for physical abuse after their fracture. Significant variation in the use of skeletal surveys and in CPCC decision of physical abuse was noted in children attending different hospitals. CONCLUSIONS: It is a concern that significant variation between hospitals was found in the investigation and detection of physical abuse as confirmed by CPCC decisions. To minimise failure to detect true cases of physical abuse, we recommend that all high-risk children should be assessed by a paediatrician prior to discharge from the emergency department. Our proposed criteria for assessment (where we found probability of CPCC decision of physical abuse was at least 10%) are any child under the age of 12 months with any fracture, under 18 months of age with femur fracture and under 24 months with humeral shaft fracture (not supracondylar).

Femoral neck stress fracture in a sanitary worker.

Stress fractures of the femoral neck are uncommon, it is important to have a high index of suspicion in young active people who perform repetitive vigorous activity or have recently had an increase in frequency of such activity. We report a case of femoral neck stress fracture in a sanitary worker which was treated successfully with a dynamic hip screw.

Microscooter injuries in the paediatric population.

OBJECTIVES: To illustrate the types of injuries seen by the accident and emergency department as a result of the use of non-motorized 'microscooters' in children, and to increase awareness of scooter-related triplane fractures of the ankle. STUDY DESIGN: A retrospective study conducted in an accident and emergency department of a district general hospital on all children who had a scooter-related limb injury over a 6-month period and were referred for orthopaedic review. METHODS: The analysis involved a case note review. Information recorded included the injury sustained, protective equipment worn at the time of the accident and management by the orthopaedic team. RESULTS: Scooter injuries accounted for 10 fractures in this period. There were three 'triplanar' injuries, which required operative fixation, and three injuries requiring manipulation under anaesthesia. No protective gear was worn by any of the patients. CONCLUSION: The popularity of microscooters seems to represent a significant risk of bony injury in the paediatric population. Medical personnel who manage acute paediatric trauma should be aware of scooter-related triplanar ankle injuries.