Long bone fracture characteristics in children with medical conditions linked to bone health

Accidental Physical Trauma in Children and Youth with Special Health Care Needs: A Scoping Review

BACKGROUND

Children and youth with special health care needs (CYSHCN) may be at greater risk for accidental physical trauma. Interventions should be informed by the literature indicating incident characteristics and at-risk subpopulations.

OBJECTIVE

To conduct a scoping review of accidental physical trauma in CYSHCN to characterize published literature and identify gaps.

DATA SOURCES

Peer-reviewed literature within CINAHL, Embase, and PubMed, 1998 to February 2021.

STUDY ELIGIBILITY CRITERIA

Studies that included individuals younger than 19 with special health care need(s) with accidental injuries classified as trauma.

STUDY APPRAISAL AND SYNTHESIS METHODS

The study team extracted: research method, author field, special health care needs, geographic scope, author country, demographics, incident characteristics, and injury characteristics.

RESULTS

We included 85 articles from an initial yield of 10,481. Pediatrics (32%) was the most-represented field among authors published on this topic. Publications most often considered developmental conditions (77.7%), including Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). Studies differed in how often they reported demographic characteristics: gender (96.5%); social determinants of health/socioeconomic status (41.2%) or race and ethnicity (25.9%). Few articles included injury time of day (10.6%) and day of week (2.4%); 40% did not include information about the place of injury.

LIMITATIONS

Our search term development focused on diagnosis rather than need; we did not search reference lists or grey literature.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

This review reveals key gaps in the literature pertaining to incident characteristics and place of injury for CYSHCN. Those advising families and/or planning interventions focused on mitigating risk for CYSHCN have limited evidence upon which to rely for certain conditions.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO registration is not applicable to scoping reviews.

Femur morphology in healthy infants and young children

The objective of this study was to characterize femur morphology in healthy infants and young children. Anterior-posterior (AP) radiographs of the femur from children age 0-3 years with no history of bone disease were obtained from two children's hospitals and one medical examiner's office. Femur morphological measures (bone length, minimum diaphysis diameter, growth plate width, and femur radius of curvature) and sectional structural measures were determined. Measures were described and compared based on subject age and mass. Relationships between measures and age and mass were evaluated. The 169 AP femur radiographs were obtained from 99 children (59.6% males, median age = 12.0 months, IQR = 0-27.5 months, median body weight = 10.0 kg, IQR = 4.4-15.6 kg). Femur length (r_s  = 0.97, p < 0.001; r_s  = 0.89, p < 0.001), trochanter width (r_s  = 0.86, p < 0.001; r_s  = 0.85, p < 0.001), minimum diaphysis diameter (r_s  = 0.91, p < 0.001; r_s  = 0.87, p < 0.001), and growth plate width (r_s  = 0.91, p < 0.001; r_s  = 0.84, p < 0.001) increased with age and weight, respectively. Cross-sectional area (r_s  = 0.87; r_s  = 0.86; p < 0.01), polar moment of inertia (r_s  = 0.91; r_s  = 0.87; p < 0.001), moment of inertia (r_s  = 0.91; r_s  = 0.87; p < 0.001), polar modulus (r_s  = 0.91; r_s  = 0.87; p < 0.001) and medullary canal diameter (r_s  = 0.83, p < 0.001; r_s  = 0.73, p < 0.001) at the minimum diaphysis also increased with age and weight, respectively. Changes during rapid bone growth are important to understanding fracture risk in infants and young children as they transition to independent walking. Femur length, trochanter width, minimum diaphysis diameter and growth plate width increased with age and weight. Structural properties associated with fracture resistance also increased with age and weight.

Vitamin D, rickets and child abuse: controversies and evidence

Suboptimal vitamin D status is a global health issue that affects children and adults worldwide. The prevalence of vitamin D deficiency and insufficiency has been well documented in the pediatric population in the United States. Although vitamin D deficiency is common, radiographic findings are uncommon and can be subtle. Additionally, because of the high prevalence of pediatric vitamin D insufficiency, it is commonly identified in young children with fractures. However, the majority of pediatric fractures are caused by trauma to healthy bones. Some, especially in infants and toddlers, are caused by non-accidental trauma. A small percentage is related to medical disease, including those associated with disorders of collagen, disorders of mineralization, and non-fracture mimics. Despite the scientific evidence, among disorders of mineralization, non-rachitic disorders of vitamin D have become a popular non-scientific theory to explain the fractures identified in abused children. Although infants and young children with rickets can fracture bones, the vast majority of fractures identified in abused infants are not caused by bone disease. Here we present a review of the literature on bone disease in the setting of accidental and non-accidental trauma. This context can help physicians remain vigilant about identifying vulnerable young children whose injuries are caused by non-accidental trauma.