Incidence of fractures among children with burns with concern regarding abuse

UMMS Affiliation

Department of Pediatrics



Document Type


Medical Subject Headings

Age Distribution; Bone and Bones; Brain Injuries; Burns; Child Abuse; Contusions; Female; Fractures, Bone; Humans; Incidence; Infant; Male; Multiple Trauma; Retrospective Studies




OBJECTIVE: Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult>fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns.

METHODS: We performed retrospective analyses of data collected as part of the Using Liver Transaminases to Recognize Abuse (ULTRA) research network. Data were collected for all children <5 years of age who were referred to 19 child protection teams for subspecialty child abuse evaluations over 1 year>(N = 1676). We compared the rate of fractures in children presenting with burns with that in other children evaluated for abuse.

RESULTS: Of 97 children <24 months of age with>burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of>age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures.

CONCLUSION: The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of>age.

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Citation: Pediatrics. 2010 Feb;125(2):e295-9. Epub 2010 Jan 18. Link to article on publisher's site


Rebecca Moles and Carolyn Keiper of the University of Massachusetts Medical School are also ULTRA Investigators.

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