Appendices : Appendix C

Transverse

Fracture line perpendicular to long axis of the bone

Direct force to the bone

Associated with accidental and non-accidental injury.

Spiral

Fracture line curves around a portion of the bone

Indirect twisting or torsion forces to the bone

May be associated with abusive injuries primarily in infants and young toddlers.

Seen with accidental injury in ambulatory children with a history of twisting injury.

Oblique

Fracture line angled across long axis of the bone

Indirect twisting forces, similar to spiral fractures

Seen in accidental and non-accidental injury.

Toddler's Fracture

A nondisplaced spiral fracture of the tibia

Initial radiographs may miss the fracture and the fracture is diagnosed by bone scan at time of presentation or on plain films repeated in apporximately 2 weeks.

Common accidental injury in children between the ages of 1 and 3

Occurs with routine play activities. May result from running and slipping, jumping and falling, and even sliding with a difficult landing.

There may be a delay in seeking medical care because the injury does not initially appear significant. Uncommonly results from abuse.

Greenstick Fracture

An incomplete fracture

Compressed side of bone is bowed, but not completely fractured.

Occurs secondary to plasticity of a child’s bone

Commonly accidental and not commonly reported in the abused child.

Torus (Buckle) Fracture

Localized buckling of the cortex of the bone

Injuries located toward metaphysis of the bone.

Due to the anatomy of the developing bone.

Results from forces applied parallel to long axis of the bone

Commonly accidental and not commonly reported in the abused child.

Impacted Fracture

Involves entire bone

Commonly accidental and not commonly reported in the abused child.