SOFT-TISSUE SWELLING WITH FRACTURES - ABUSE VERSUS NONINTENTIONAL

The objectives were to 1) define the amount of postfracture swelling a t presentation in long bone fractures, and 2) to study the relationshi p between suspected abuse and/or neglect (A/N) and degree of postfract ure swelling at presentation, This was a prospective study of 37 patie nts less than 11 years of age presenting with long bone fractures to t he emergency department (ED) of the Children's Hospital of Michigan be tween August 1992 and December 1992, Data were recorded at the time of the ED visit and from medical records which were reviewed four to six months later, Of the patients enrolled in the study, eight were categ orized as A/N and 29 as nonintentional, There was no difference in rep orted injury age between the two groups (15.5 +/- 24.5 hours vs 14.0 /- 17.7, P = 0.8), At presentation the mean increase in circumference from postfracture swelling was 9.6 +/- 7.1%, using the uninjured extre mity as the control, The abuse group had a lesser increase in circumfe rence compared to the nonintentional group, even after adjusting for i njury age (3.8 +/- 3.6% vs 11.2 +/- 7.0%, P < 0.006), We concluded tha t patients with long bone fractures had a mean swelling of 9.6 1 7.1% at presentation. Injuries induced by A/N present with less swelling th an similar injuries sustained nonintentionally, and we speculate that this difference indicates that the history and/or time of injury may n ot be reliable.