Radiological features of healing in newborn clavicular fractures
Given the frequency of abusive fractures among infants, and the lack of research and or evidence for the phases of fracture healing seen in this age group, this study aims to describe a timetable of radiological features of fracture healing among infants in the first months of life.
We completed a retrospective cross-sectional time-series study of birth-related clavicle fractures from 2006–2013. A total of 108 digital images were available for review from 61 infants. The presence or absence of four features of healing including periosteal reaction, callus formation, bridging callus and remodelling were scored by three radiologists.
The level of agreement between the radiologists was good to high (0.60–0.90). Features of healing were first seen at 7 days (periosteal reaction), 11 days (callus), 20 days (bridging) and 35 days (remodelling), respectively. The peak periods that each feature was present are as follows: periosteal reaction 11–42 days, callus 12–61 days, bridging 22–63 days and remodelling 49–59 days.
Birth-associated clavicle fractures in infants follow a logical progression of healing changes. Understanding the expected progression and timing of fracture healing may be helpful as it pertains to the timing of injury in cases of abuse in infants.
• Large study describing the time frames of fracture healing in young infants.
• Features of fracture healing develop in a logical progression.
• Evidence provided for determining fractures are consistent with a proposed time frame.
• It is of critical importance to have sound evidence for the dating of fractures.
KeywordsClavicle Abuse Non-accidental trauma Healing fracture Fracture healing
The scientific guarantor of this publication is Sabine Maguire, MBBCh, MRCPI, FRCPCH. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors, Laszlo Trefan, PhD, has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational/experimental, performed at one institution.
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