title: Pattern of fractures in non-accidental injuries in the pediatric population in Singapore.
abstract: BACKGROUND
  Fractures as a result of non-accidental injuries (NAI) are not uncommon among children. The purpose of our study was to describe the incidence, demographic characteristics, and associated risk factors in patients with NAI in a multiethnic Asian cohort.
  
  
  METHODS
  A retrospective record review of patients admitted to our hospital between September 2007 and 2009 with the diagnosis of NAI was conducted.
  
  
  RESULTS
  A total of 978 children were reported with suspicion of NAI. Among them, 570 patients (58.28%) were diagnosed with NAI. Fractures were observed in 35 children (6.14%). NAI fractures were highest among female infants (73.3%). The biological father was the most common known perpetrator of NAI (n = 155, 29.0%). The most common perpetrator sadly remained unknown (n = 14, 40%). All NAI fractures were closed (n = 35, 6.14%), and the most commonly affected bone was the humeral shaft (n = 10, 28.57%) with an oblique configuration. Age < 1 year and parental divorce were significant risk factors associated with these fractures.
  
  
  CONCLUSIONS
  The skeletal injury pattern and risk factors highlighted in our study will help treating physicians identify patients susceptible to NAI, as many of these patients are young and vulnerable. Protective measures can be initiated early by recognizing these injuries and preventing further physical and psychological harm to the child.
authors.affiliation: Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore.
authors.forename: Sumanth Kumar
authors.initials: SK
authors.lastname: Gera
authors.affiliation: Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Raveendran
authors.affiliation: Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore.
authors.forename: Arjandas
authors.initials: A
authors.lastname: Mahadev
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
keywords: Bone fractures; Child abuse; Etiology; Risk factors