APPENDIX F: Common Types of Diaphyseal Fractures Seen in Childhood :: Child Abuse Evaluation & Treatment for Medical Providers :: Child Abuse MD :: SUNY Upstate Medical University

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.

Appendices 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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