Fracture dating

How accurate is radiologic dating of fractures in children?

Radiologic dating of fractures is an inexact science. Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource. There is an urgent need for research to validate the criteria used in the radiologic dating of fractures in children younger than 5 years.

Is there a scientific basis for fracture dating in abuse cases?

While some scientific studies have been published on fracture dating in general, prior reports have shortcomings that limit the applicability of data to cases of abuse ( 3, 4, 6, 10, 32 –34). Inflicted skeletal injuries are more common in younger age groups and most frequent in infants ( 15 –18).

Can a bone scan be used to date a fracture?

No details were given as to what specific features were used for dating in this study. Bone scans have no place in fracture dating because they show positive results within 7 hr of injury [33] and can continue to show positive results for as long as 1 year.

How should fractures in young children be dated?

The results of this study show that fractures in young children may be dated as acute (< 1 week), recent (8???35 days), or old (??? 36 days) on the basis of the presence of six key radiologic features in combination. Furthermore, good interobserver agreement suggests these results are reproducible.

How accurate is radiologic dating of fractures?

Conclusion: Radiologic dating of fractures is an inexact science. Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource.

How is the date of a fracture in children determined?

Dating of fractures in children is an inexact science. The radiologic features of bone healing are a continuum, with considerable overlap. Radiologic estimates of the time of injury are made in terms of weeks rather than days. It is vital for all investigating agencies to be aware of these broad time frames.

How do radiologists determine the age of fractures?

Radiologists usually determine the age of fractures based on clinical experience and guidance offered in textbooks [ 21 ]. Unfortunately the terms describing the phases of healing differ between the two included studies that offer criteria [ 19, 20 ], and these differ from the terminology in Kleinmans textbook [ 21] ( Table 3 ).

Can a bone scan be used to date a fracture?

No details were given as to what specific features were used for dating in this study. Bone scans have no place in fracture dating because they show positive results within 7 hr of injury [33] and can continue to show positive results for as long as 1 year.

How do you date fractures in young children?

A timetable for the radiologic features of fracture healing in young children The results of this study show that fractures in young children may be dated as acute (< 1 week), recent (8-35 days), or old (≥ 36 days) on the basis of the presence of six key radiologic features in combination.

What percentage of child fractures are caused by abuse?

Fractures have been recorded in as many as 55% of young children who have been physically abused, 1-3 18% of whom have multiple fractures. 1 Fractures in physical child abuse denote severe assault and young children are at greatest risk of abusive fractures.

When to not seek care for a fracture in a child?

not seeking care after 24 h in any child less than 11 months of age or in children 12–23 months of age when the fracture is associated with significant pain and/or physical findings; additional injuries on examination unrelated to fracture (eg, burns and bruises); no trauma/explanation for fracture.

How accurate is radiologic dating of fractures in children?

Radiologic dating of fractures is an inexact science. Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource. There is an urgent need for research to validate the criteria used in the radiologic dating of fractures in children younger than 5 years.