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Chapter 4 - Upper extremity trauma

from Section I - Skeletal trauma

Published online by Cambridge University Press:  05 September 2015

By
Paul K. Kleinman
Edited by
Paul K. Kleinman
Paul K. Kleinman
Affiliation:
Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
Paul K. Kleinman
Affiliation:
Children's Hospital Boston
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Summary

The humerus

The humerus is one of the most frequently injured bones in abused children. In Caffey’s original report of long bone injuries and subdural hematomas (SDHs), three of six cases had bilateral humeral fractures (1). Caffey’s correspondence with Ingraham revealed an additional case of a humeral fracture with SDH (1, 2). Reports that followed included examples of humeral lesions (3–9). Studies of fractures in abused children have found the humerus to be the second or third most common long bone fracture, following the tibia and/or femur (10–15). In their 2007 review of the US Kids’ national database Loder and Feinberg found that the humerus was the third most common long bone region to be fractured (N = 74) in abused infants, exceeded by the femur (N = 150) and the tibia/fibula/ankle (N = 98) (15). Among children 1–2 years of age the number of humeral fractures was slightly greater than the number of femur fractures (N = 28 vs. N = 26). Similarly, in their study of 500 abused children less than 4 years old, Pandya et al. found that the humerus was the third most common long bone region fractured (8.6%), preceded by the femur (14.6%) and tibia/fibula (11%) (16). When broken down by age, the proportions of children under 18 months with fractures involving the femur, tibia/fibula, and humerus were 17.5%, 13.3%, and 9.8% respectively, versus 5.7%, 4.1%, and 4.9% for children greater than 18 months.

Several authors have found the humerus to be the most common long bone injury (17–19). These frequencies vary, depending on the types of populations studied, age distribution, and imaging techniques employed. When high-detail skeletal surveys (SSs) are performed in infant fatalities, metaphyseal injuries of the femurs and tibias tend to predominate, and, thus, the humerus is a less common site of injury than the lower extremities in this younger age group (20). In a review of 567 high-detail SSs done for suspected infant abuse, fractures of the humerus were less common than the long bones of the lower extremities (21).

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Diagnostic Imaging of Child Abuse , pp. 121 - 163
Publisher: Cambridge University Press
Print publication year: 2015

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  • Upper extremity trauma
    • By Paul K. Kleinman, Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.012
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  • Upper extremity trauma
    • By Paul K. Kleinman, Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.012
Available formats
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  • Upper extremity trauma
    • By Paul K. Kleinman, Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.012
Available formats
×