Patterns of injury

Patterns of injury

There are some well-recognised patterns of injury in children. Lap belt If a child experiences a forced flexion over a lap belt in a car accident, the small bowel or its mesentery or the bladder’s abdominal portion may get compressed against the spine. These tissues may fail up to 72 /uni00A0 hours after the injury . Lumbar fractures may also be seen. In small children, the pancreas can be compressed by a lap belt. Handlebar injury A child who falls onto the end of a bicycle handlebar may crush the pancreas, duodenum, small intestine or its mesentery against the spine. A duodenal haematoma may cause an obstruction, the pancreas may be injured or divided and contused intestine may perforate after a delay of a few days, so a period of observation is required. When this injury pattern is seen in a child under 3 /uni00A0 years old, a non-accidental injury must be considered. Straddle injury A child typically falls onto the side of a bath or a toy , causing a perineal injury that may involve the urethra or vagina. Non-accidental injury Non-accidental injuries should be suspected when the reported mechanism of injury or its timing are unusual. Fractures, under 2 /uni00A0 years old are often non-accidental. Bruises are remark ably di ffi cult to date, but their shape and pattern may distin guish accidental from abusive bruising if they leave an imprint. Patterned bruises generally do not occur during regular play . Bruises over soft tissues in an immobile infant are suspicious, whereas those over bony prominences such as the knees elbows and the forehead in a mobile child are not. Bruises on the cheeks, neck, genitals, buttocks and back are unlikely to be accidental. Some benign entities may be confused with abusive bruises, such as Mongolian spots and haemangiomas. Children with idiopathic thrombocytopenic purpura or leukaemia may present with unexplained bruises in di ff erent stages of healing. Patterns of injury

There are some well-recognised patterns of injury in children. Lap belt If a child experiences a forced flexion over a lap belt in a car accident, the small bowel or its mesentery or the bladder’s abdominal portion may get compressed against the spine. These tissues may fail up to 72 /uni00A0 hours after the injury . Lumbar fractures may also be seen. In small children, the pancreas can be compressed by a lap belt. Handlebar injury A child who falls onto the end of a bicycle handlebar may crush the pancreas, duodenum, small intestine or its mesentery against the spine. A duodenal haematoma may cause an obstruction, the pancreas may be injured or divided and contused intestine may perforate after a delay of a few days, so a period of observation is required. When this injury pattern is seen in a child under 3 /uni00A0 years old, a non-accidental injury must be considered. Straddle injury A child typically falls onto the side of a bath or a toy , causing a perineal injury that may involve the urethra or vagina. Non-accidental injury Non-accidental injuries should be suspected when the reported mechanism of injury or its timing are unusual. Fractures, under 2 /uni00A0 years old are often non-accidental. Bruises are remark ably di ffi cult to date, but their shape and pattern may distin guish accidental from abusive bruising if they leave an imprint. Patterned bruises generally do not occur during regular play . Bruises over soft tissues in an immobile infant are suspicious, whereas those over bony prominences such as the knees elbows and the forehead in a mobile child are not. Bruises on the cheeks, neck, genitals, buttocks and back are unlikely to be accidental. Some benign entities may be confused with abusive bruises, such as Mongolian spots and haemangiomas. Children with idiopathic thrombocytopenic purpura or leukaemia may present with unexplained bruises in di ff erent stages of healing. Patterns of injury

There are some well-recognised patterns of injury in children. Lap belt If a child experiences a forced flexion over a lap belt in a car accident, the small bowel or its mesentery or the bladder’s abdominal portion may get compressed against the spine. These tissues may fail up to 72 /uni00A0 hours after the injury . Lumbar fractures may also be seen. In small children, the pancreas can be compressed by a lap belt. Handlebar injury A child who falls onto the end of a bicycle handlebar may crush the pancreas, duodenum, small intestine or its mesentery against the spine. A duodenal haematoma may cause an obstruction, the pancreas may be injured or divided and contused intestine may perforate after a delay of a few days, so a period of observation is required. When this injury pattern is seen in a child under 3 /uni00A0 years old, a non-accidental injury must be considered. Straddle injury A child typically falls onto the side of a bath or a toy , causing a perineal injury that may involve the urethra or vagina. Non-accidental injury Non-accidental injuries should be suspected when the reported mechanism of injury or its timing are unusual. Fractures, under 2 /uni00A0 years old are often non-accidental. Bruises are remark ably di ffi cult to date, but their shape and pattern may distin guish accidental from abusive bruising if they leave an imprint. Patterned bruises generally do not occur during regular play . Bruises over soft tissues in an immobile infant are suspicious, whereas those over bony prominences such as the knees elbows and the forehead in a mobile child are not. Bruises on the cheeks, neck, genitals, buttocks and back are unlikely to be accidental. Some benign entities may be confused with abusive bruises, such as Mongolian spots and haemangiomas. Children with idiopathic thrombocytopenic purpura or leukaemia may present with unexplained bruises in di ff erent stages of healing.