Purpose or Case Report: Skeletal fractures may go undetected and untreated in physically abused children for significant periods of time. When discovered later through radiographic survey, the time since injury (TSI) may be important for the medical diagnosis of physical abuse and have implications for child protection. Prior research suggests that clinical and biological variables, such as fracture location and age, may influence pediatric fracture healing. However, radiographic determination of TSI has been poorly studied until recently. It has been commonly understood that in general younger patients heal faster and lower extremity fractures heal slower than upper extremity fractures. However, the influence of patient age and fracture location on fracture healing has only been explored on a limited scale and not between pediatric age groups. This study examines the effect of age on specific features of pediatric fracture healing through radiographic analysis.
Methods & Materials: Four hundred ninety-eight upper and lower limb skeletal fractures (>1355 radiographs) of children ages 0 to 5.99 years old were evaluated for features of fracture healing at a large tertiary care center. Abuse-related fractures and individuals with co-morbidities or disorders affecting bone were excluded. Subperiosteal new bone formation (SPNBF) and callus were evaluated along with the time to complete healing. The presence, thickness, matrix, and character were recorded based on modified parameters set by Walters et al. (2014).
Results: Independence and goodness of fit frequency tests revealed correlations between age and the thickness and character of SPNBF as well as callus matrix and fracture margin definition, in addition to within bone location and bone type and rate of healing. Mean comparisons reveal significant differences in callus matrix thickness between younger and older age groups (p < 0.001). Statistical tests reveal no significant differences between sex and other variables of fracture healing.
Conclusions: These results may provide an improved method of determining the age of fractures and TSI. Future research may provide better guidelines for radiographic characterization of fracture healing, and improved confidence in the estimation of TSI.