title: Radiological features of healing in newborn clavicular fractures.
abstract: OBJECTIVE
  Given the frequency of abusive fractures among infants, and the lack of research and or evidence for the phases of fracture healing seen in this age group, this study aims to describe a timetable of radiological features of fracture healing among infants in the first months of life.
  
  
  METHODS
  We completed a retrospective cross-sectional time-series study of birth-related clavicle fractures from 2006-2013. A total of 108 digital images were available for review from 61 infants. The presence or absence of four features of healing including periosteal reaction, callus formation, bridging callus and remodelling were scored by three radiologists.
  
  
  RESULTS
  The level of agreement between the radiologists was good to high (0.60-0.90). Features of healing were first seen at 7 days (periosteal reaction), 11 days (callus), 20 days (bridging) and 35 days (remodelling), respectively. The peak periods that each feature was present are as follows: periosteal reaction 11-42 days, callus 12-61 days, bridging 22-63 days and remodelling 49-59 days.
  
  
  CONCLUSIONS
  Birth-associated clavicle fractures in infants follow a logical progression of healing changes. Understanding the expected progression and timing of fracture healing may be helpful as it pertains to the timing of injury in cases of abuse in infants.
  
  
  CONCLUSIONS
  • Large study describing the time frames of fracture healing in young infants. • Features of fracture healing develop in a logical progression. • Evidence provided for determining fractures are consistent with a proposed time frame. • It is of critical importance to have sound evidence for the dating of fractures.
authors.affiliation: Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO, 80045, USA. michael.fadell@childrenscolorado.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Fadell
authors.affiliation: Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO, 80045, USA.
authors.forename: Angie
authors.initials: A
authors.lastname: Miller
authors.affiliation: , 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF 144YS, UK.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Trefan
authors.affiliation: Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO, 80045, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Weinman
authors.affiliation: Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO, 80045, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO, 80045, USA.
authors.forename: Kari
authors.initials: K
authors.lastname: Hayes
authors.affiliation: Early Years Research Program, Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF 144YS, UK.
authors.forename: Sabine
authors.initials: S
authors.lastname: Maguire
mesh_terms: D001720:Birth Injuries / Q000000981:diagnostic imaging*; D002146:Bony Callus / Q000503:physiopathology; D002649:Child Abuse / Q000175:diagnosis; D002968:Clavicle / Q000293:injuries*; D003430:Cross-Sectional Studies; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D011859:Radiography; D012189:Retrospective Studies
keywords: Abuse; Clavicle; Fracture healing; Healing fracture; Non-accidental trauma