Incidence, pattern and mechanisms of injuries and fractures in children under two years of age: a population-based study.

BACKGROUND

Epidemiological data on injuries and fractures in children under two years of age is limited, thus, we aimed to explore the incidence, patterns and mechanisms.

METHODS

Retrospective, population-based cross-sectional study including children under two, seen at the A&E department due to a trauma, or having a radiograph due to birth trauma. All radiographs were re-reviewed.

RESULTS

Four hundred thirty children (49.8% female), mean age 14.7 months (SD 6.8), were included, of whom four had a high-energy trauma and 42 were birth-related. Of 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with non-birth related injury, 163 (42.0%) had a fracture (annual incidence 4.3 per 1,000 children; 2.4 per 1,000 infants vs. 6.1 per 1,000 children aged 12 to 24 months of age. 47/163 (28.8%) fractures involved the forearm and 41 (25.2%) involved the leg. Fracture mechanisms 39.9% fall from more than own height/furniture; 17.2% fall from own height, 6.7% crush injury and 6.1% dropped by parent. In 12.9% of the traumas, no mechanism was provided. The number of fractures increased significantly by age group (p=0.027), and the distribution differed, with skull fractures predominating in 0-6-months-old (33.0%), clavicle fractures (33.0%) in 6-12-months-old and forearm fractures in the two older age groups (35.0% and 34.4%, respectively) (p < 0.001). No classic metaphyseal lesions were found in the entire cohort. Four children, all of whom had radiological "red flags", had inflicted injury. Forty-two children had birth-related injury, of whom 50.0% had a fracture (1.1 per 1,000 live births).

CONCLUSIONS

Fractures in infants are rare, in particular classic metaphyseal fractures. The occurrence of radiological "red flags" should raise suspicion of non-accidental injury and instigate further assessment.