title: Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse?
abstract: OBJECTIVE
  To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries.
  
  
  METHODS
  A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse.
  
  
  RESULTS
  Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures.
  
  
  CONCLUSIONS
  The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Strait
authors.forename: R M
authors.initials: RM
authors.lastname: Siegel
authors.forename: R A
authors.initials: RA
authors.lastname: Shapiro
mesh_terms: D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data; D002675:Child, Preschool; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology*; D007223:Infant; D015995:Prevalence; D012189:Retrospective Studies