Child abuse is the leading cause of trauma-related fatalities in children less than four years of age. Children one year of age and younger are particularly at risk;approximately 1 out of every 48 children in this age group is a victim of abue or neglect. Cases of physical child abuse are commonly mistaken for accidental trauma. If the abuse goes unrecognized, the child is at risk for further, escalating injuries. An abused child returned to an unsafe home environment has up to an 80% risk for additional injury and up to a 30% risk of death. These repeat occurrences may be preventable through early detection of abuse. Fractures are early indicators of child abuse, but are also a common result of accidental trauma, such as household falls. Clinicians are often faced with the task of determining whether a child's injuries are the result of accidental causes or whether abuse should be suspected. Since household falls are a common false history given by caretakers to conceal abusive trauma, information regarding fracture potential in short-distance falls and specifically what type of fracture could result from different fall scenarios, may aid clinicians in distinguishing abusiv from accidental injuries, thus improving the accuracy of child abuse diagnoses. The purpose of this study is to provide objective, biomechanically-based information regarding femur fracture potential in short-distance falls.
Three specific aims have been established to address this goal: (1) Describe femur loading (type and magnitude) associated with short-distance falls in young children, (2) Describe the likelihood of femur fractures in short-distance falls, (3) Develop an improved understanding of the influence of child-specific bone characteristics on fracture potential. This study will involve three primary methodological components. First, a CRABI 12-month-old anthropomorphic test device (ATD) will be modified to improve biofidelity of the lower extremities and instrumented to measure femur loads. Then, fall simulations will be conducted using the improved surrogate to determine femur loading characteristics. The final component involves development of a finite element model of a 12-month-old human child's femur. Femur loads from the ATD experiments will be reproduced in the finite element model. This will provide insight into fracture potential for the combined loading scenarios measured experimentally. Additionally, key parameters will be varied in the model as part of a sensitivity analysis to determine their effect on fracture potential. This will elucidate the effect of child-specific characteristics (such as bone density) on femur fracture potential. The outcomes from this study will provide an improved understanding of femur fracture potential in short-distance pediatric falls and lay the foundation for future work that will improve clinical assessments of injury and history compatibility. Additionally, though this study focuses on femur fracture potential, the approach used may serve as a model for future investigation of fracture potential in other bones.

Public Health Relevance

Clinicians are often challenged with determining whether a child's injuries are the result of accidental causes or whether abuse should be suspected. Since this decision often depends on the clinician's experience, objective information about fracture potential in short-distance falls (a common excuse provided to conceal abuse) such as the location and type of fractures possible under various loading conditions, will improve accuracy in child abuses diagnoses and the likelihood of earlier identification of child abuse.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Developmental Biology Subcommittee (CHHD)
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Maholmes, Valerie
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University of Louisville
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Biomed Engr/Col Engr/Engr Sta
United States
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Thompson, Angela; Bertocci, Gina; Smalley, Craig (2018) Femur loading in feet-first fall experiments using an anthropomorphic test device. J Forensic Leg Med 58:25-33