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Child Abuse

Spiral Fractures in A Young Child

11/16/2006

Question:

How much force would be required to cause a spiral fracture of the distal shaft of the humerus in a 9 month old child? Might such an injury occur by the child entangling their arm in a baby bouncer or by an adult trying to extracating him?

Answer:

The humerus may be fractured from accidental causes.  Typically, when the fracture occurs, the child will experience severe pain and will demonstrate this by crying and irritability.  However, because infants are not verbal, caretakers may find it difficult to recognize the cause of the infant's distress.

Bones fracture with a spiral pattern if there are twisting forces applied to the bone at the time of injury. 

It is possible for the humerus to be fractures by the two mechanisms you mention above.  Child protective workers and police may find it difficult to differentiate between abusive fractures and accidental fractures, however, when there is no history of the trauma but only speculation.

Additional medical workup to examine for other trauma, as well as a thorough social evaluation, may assist in differentiating between abuse and accident.

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Response by:

Robert Shapiro, MD
Professor of Clinical Pediatrics
College of Medicine
University of Cincinnati