During your snotty/barfy/whiny evening shift at a made-up-HIPPA-compliant hospital, an 11-month-old child is brought to the ED by his parents for excessive crying. The child spends his days at “Jerks-are-Us Daycare” while his parents are working for “the man.” The child is usually able to pull-to-stand but today he lays in the ED crib on his side crying. Physical exam shows a well-developed, well-nourished child who is at the appropriate developmental stage. The child cries on exam,is somewhat consolable by the parents, but appears uncomfortable. On physical exam, the child screams on palpation of the right arm at the elbow. You perform an x-ray of the upper extremity.
What 2 long-bone fractures are concerning for non-accidental trauma? What mechanism of injury causes each fracture?
answerCorner fracture: this is caused when a strong force such as yanking or aggressive pulling is applied to a long-bone. It results in an avulsion fracture of the “corner” of the bone at the epiphysis.
Spiral Fracture: this is caused by twisting of an extremity. It looks like an oblique, comminuted, often displaced fracture in the diaphysis of a long bone.
We are mandatory reporters: If you are AT ALL suspicious of non-accidental trauma, call your local child protection services and immediately involve your ED Social Worker.
By: Andrew Grock and Sally Bogoch, Board Review 4 Life.
Rosen’s Emergency Medicine: 7th Edition.
sbogoch
Latest posts by sbogoch (see all)
- Management of the Post-Cardiac Arrest Patient - April 9, 2015
- 3/10/2015: Bored of Cardiologists, not Cardiology - March 10, 2015
- Bored review: 3/3/2015 Looking Beyond the Injury - March 3, 2015
0 Comments