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APPENDIX F: Common Types of Diaphyseal Fractures Seen in Childhood

Type Characteristics Causes
Transverse

Transverse bone fracture

Fracture line perpendicular to long axis of the bone Direct force to bone

Associated with accidental and non-accidental injury.

Spiral

Spiral bone fracture

Fracture line curves around a portion of the bone Indirect twisting or torsion forces to the bone

May be associated with abusive injuries primarily in infants and young toddlers.

Seen with accidental injury in ambulatory children with a history of twisting injury.

Oblique

Oblique bone fracture

Fracture line angled across long axis of the bone Indirect twisting forces, similar to spiral fractures
Seen in accidental and non-accidental injury.
Toddler's fracture

Toddler's bone fracture

A nondisplaced spiral fracture of the tibia

Initial radiographs may miss the fracture and the fracture is diagnosed by bone scan at time of presentation or on plain films repeated in approximately 2 weeks.

Common accidental injury in children between the ages of 1 and 3

Occurs with routine play activities. May result from running and slipping, jumping and falling, and even sliding with a difficult landing. There may be a delay in seeking medical care because the injury does not initially appear significant. Uncommonly results from abuse.

Greenstick fracture

Greenstick bone fracture

An incomplete fracture

Compressed side of bone is bowed, but not completely fractured.

Occurs secondary to plasticity of a child's bone

Commonly accidental and not commonly reported in the abused child.

Torus (buckle) fracture

Torus bone fracture

Localized buckling of the cortex of the bone

Injuries located toward metaphysis of the bone.Due to anatomy of the developing bone.

Results from forces applied parallel to long axis of the bone

Commonly accidental and not commonly reported in the abused child.

Impacted fracture Involves entire bone Commonly accidental and not common in child abuse

Adapted from Giardino AP, Christian CW, Giardino ER. A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. Thousand Oaks, CA: Sage Publications; 1997.


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Appendices  Appendix A: Post-Assault Testing and Treatment  Appendix B: A Sample Continuum of Medical History Questions and Confidence in the Responses  Appendix C: Body Diagrams  Appendix D: Burn Assessment - Rule of Nines  Appendix F: Common Types of Diaphyseal Fractures Seen in Childhood  Appendix G: Findings That May Be Confused with Abuse  Appendix H: Differential Diagnosis Table  Appendix I: List of Community Services  Appendix J: Supplemental Resources  Appendix K: Emergency Contraceptive Pills 

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