Abstract
Skeletal fractures, a common injury in physically abused children, often go undetected and untreated for significant lengths of time and are sometimes incidentally discovered radiographically. Our objective was to review current literature for scientific studies of pediatric fracture healing with associated timelines. We conducted a search of Embase, EBSCOhost, MEDLINE (PubMed), and Web of Science for literature published from the earliest available up to August 2018. We evaluated the included articles for quality, with consideration for use in clinical and forensic settings. Of a total of 313 full-text articles evaluated, 10 met study inclusion criteria. The patient age range among studies was 0–17 years, with children younger than 1 year included in the majority of studies. The fracture locations included in studies were primarily fractures of the upper limb and pectoral girdle, followed by fractures of the lower limb. The radiographic features of healing varied greatly among the studies. Timelines of common fracture healing variables differed significantly among studies. Scientific, radiographic studies of pediatric fracture healing are limited. Gaps in knowledge regarding fracture healing highlight the need for future research and validation studies. Fracture healing timelines derived from existing timelines should be used with caution.
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Acknowledgments
Thanks to Krista Wheeler and Jiabin Shen of the Center for Injury Research and Policy for their help in developing the protocol for this systematic review. This research was supported by the Center for Injury Research and Policy at Nationwide Children’s Hospital through a grant from the Centers for Disease Control and Prevention (Grant #: 1R49CE003074-01). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Center for Injury Research and Policy.
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Farah W. Brink has provided paid expert testimony in cases of alleged child maltreatment. Payment is provided to the physician’s institution for testimony.
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Messer, D.L., Adler, B.H., Brink, F.W. et al. Radiographic timelines for pediatric healing fractures: a systematic review. Pediatr Radiol 50, 1041–1048 (2020). https://doi.org/10.1007/s00247-020-04648-7
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DOI: https://doi.org/10.1007/s00247-020-04648-7