Incidence, pattern and mechanisms of injuries and fractures in children under two years of age. A population-based study

Background: Epidemiological data on injuries and fractures in children under two years of age is limited, thus, we aimed to explore the incidence, patterns and mechanisms. Methods: Retrospective, population-based cross-sectional study including children under two, seen at the A&E department due to a trauma, or having a radiograph due to birth trauma. All radiographs were re-reviewed. Results: 430 children (49.8% female), mean age 14.7 months (SD 6.8), were included, of whom four had a high-energy trauma and 42 were birth-related. Of 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with non-birth related injury, 163 (42.0%) had a fracture (annual incidence 4.3 per 1,000 children), of which 47/163 (28.7%) involved the forearm and 40 (24.5%) involved the leg. Fracture mechanisms 23.9% fall from more than own height/furniture; 17.2% fall from own height, 15.7% crush injury and 10.6% stretch/pull trauma. In 13.6% of the traumas, no mechanism was provided. The number of fractures increased significantly by age group (p=0.039), and the distribution differed, with skull fractures predominating in 0-6-months-old (33.0%), clavicle fractures (33.0%) in 6-12-months-old and forearm fractures in the two older age groups (35.0% and 34.4%, respectively) (p < 0.001). No classic metaphyseal lesions were seen. Four children, all of whom had radiological “red flags”, had inflicted injury. 42 children had birth-related injury, of whom 50.0% had a fracture (1.1 per 1,000 live births). Conclusions: Fractures in infants are rare, in particular CMLs. The occurrence of radiological “red flags” should raise suspicion of non-accidental injury and instigate further assessment.