J. M. Rinaldi1, M. D. Hatch2, W. L. Hennrikus2 1Penn State Hershey Medical Center,College Of Medicine,Hershey, PA, USA 2Penn State Hershey Medical Center,Department Of Orthopaedics,Hershey, PA, USA
Introduction: Previous authors have reported that skull, rib, and corner fractures, and fractures in young children who have not started walking are highly associated with abuse. The purpose of this study is to determine the epidemiology, etiology, and relationship of supracondylar elbow fractures with child abuse.
Methods: 75 consecutive displaced supracondylar elbow fractures were reviewed to determine specific information about the manner in which the injury occurred. Medical records and radiographs were analyzed for demographic and injury data.
Results: 42 males (56%) and 33 females (44%) were studied. The average age was 6 years (range: 1 year 4 months to 12 years 4 months). 2 patients were 1-2 years of age, 3 were 2-3 years of age, and 70 were older than 3. The left elbow was fractured in 45 cases (60%). 87% were right hand dominant, 9% were left hand dominant, and 4% were too young to determine handedness. 58% injured the non-dominant arm. 24 (31%) were Gartland Type 2 and 52 (69%) were Gartland Type 3 fractures. 1 fracture was open. 8 (11%) fractures had a pucker sign. 11% presented with a nerve palsy. 5% presented without a pulse. 7 patients (9%) presented with an additional ipsilateral distal radius fracture. 64 fractures (85%) were transferred from 27 different outside hospitals in 17 counties, while 11 fractures (15%) presented directly to the ED. 35 fractures (47%) occurred at home, 30 (40%) on the school grounds, 4 (5%) in a gymnasium, 4 (5%) in a park, 1 at a farm show, and 1 in a parking lot. 24 fractures were treated between midnight and 8am, 15 were treated between 8am and 5pm, and 33 were treated between 5pm and midnight. All fractures stemmed from a fall, including: playground equipment 29 (39%), furniture 10 (13%), sports 6 (8%), stairs 3 (4%), bikes 3 (4%), and miscellaneous– running and tripping, falling from a toy ball, sled, tree, wagon, fence, bounce house, van, deck, power-wheels car, ATV, and go-cart. The average time from injury to the call for a transfer was 3 hours 5 minutes; transfer acceptance to arrival at ED– 2 hours 1 min; arrival in ED to OR– 5 hours 14 min; injury to OR– 10 hours 20 min; and time to discharge– 16 hours 39 min. Multiple medical professionals including outside ED physicians and orthopaedic surgeons, local ED physicians, local orthopaedic surgeons, residents, and nurses evaluated each patient. Only 1 patient, the youngest patient in the cohort at 1 year 4 months, injured from a fall at home, was reported for possible abuse and the evaluation was negative.
Conclusion: Pediatric elbow supracondylar fractures occur from accidental falls while children are at play. The mechanism involves a fall on the outstretched hand, hyperextension of the elbow, and fracture of the humeral cortex at the supracondylar location. In this population, child abuse was rarely associated with supracondylar elbow fractures.