Age dating bone fractures
The authors excluded children who had metabolic bone disease or non-accidental injury.
X-rays were reviewed independently by three paediatric radiologists who were blinded to clinical details.
They analysed the fractures for the presence or absence of six features of fracture healing: soft tissue swelling (STS), periosteal reaction, soft and hard callus, bridging and remodelling.
Results 213 of 78 fractures from 63 children (mean age 3.9 years) were analysed.
Further analysis of children under 1 year is ongoing.
Conclusion This large data set of young children defines the key features from which fracture dating can be estimated.
Bone fractures in children are different from adult bone fractures because a child’s bones are still growing.
The presence of casts in 114 cases limited interpretation.
It is possible to determine the age of a fracture as acute (less than 1 week), recent (2–5 weeks) and old (6 weeks or more) based on the presence or absence of six variables in combination.
The application of this dating tool now needs to be validated in practise.
The following is a summary of the systematic review findings up to the date of our most recent literature search.
If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.
Aims Given the clinical and legal significance of radiological fracture dating in child abuse, and the lack of primary data to support such estimations, the authors set out to determine the key radiological variables in fracture healing and their timeline.Methods The authors analysed digital x-rays (initial and follow-up) of children 5 years of age and under, presenting to a single emergency department during 2008, with accidental fractures of known timing.