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Question: NAT

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An 18 month old child has sustained an arm fracture. Per the parent, the 4 year old sibling was carrying the child and tripped.

Which of the following fracture patterns is most concerning for non-accidental trauma?

pemsou5_wp • February 13, 2018

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  1. Kelly February 13, 2018 - 8:59 am Reply

    B) Corner chip fracture of the proximal humerus
    “Corner” or “bucket handle” fractures (depending on angle viewed) are commonly seen in children < 2 years old, and are considered pathognomonic for non-accidental injury. They are also called Classic Metaphyseal Lesions. The mechanism of injury is shaking. See for more information. Other fractures highly concerning for abuse include: lateral and posterior rib fractures, femur fractures in pre-ambulatory children, humerus fractures without h/o major trauma, multiple fractures (particularly in different stages of healing), and fractures inconsistent with the history given or child’s developmental capabilities.

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