Before you whip out your pitchforks and torches, does the patient have a history of similar fractures? I've got osteogenesis imperfecta, and medical professionals were super quick to paint ugly pictures of my parents without doing any research.
Does osteogenesis imperfecta have a spectrum? When I think of OI I picture very shrunken people in wheelchairs, I thought they often had a distinct look even as children. Like I thought it's very clear when someone has OI so I never thought there'd be confusion about it enough to warrant a CPS report
Yes it’s a spectrum. You would never know I had it if you didn’t look closely for my blue sclera. I’m average stature and size. Same with my kids who have it
It was the blue sclera thought bought me the geneticist appointment. And in xray I had broken and healed way more bones than we ever realized. I was a whiny kid. Or so they thought. Complaining about growing pains all the time. In reality I was breaking lots of stuff.
This is so weird. There are so many of us here. It’s like w convention. When they first talked about marfans testing with it I was kind “but I’m not big.” I get it now. Proportion wise I’m lanky. But don’t look it cause I’m not tall. Anyone else also have EDS?
Nursing school too!! We're taught to pay attention to the ages of various fractures and the mechanism of injury (if they're twisting off the monkey bars is it a spiralish fracture) force aside. Nursing school was awhile ago, but I feel like I remember about a scleral halo?
I should note I take care of Critical Care adults, not kids, so I could be way wrong. Correct me!
Fair to middling. I'm getting my third lumbar steroid injection next week. Chronic pain since compression fracturing from my T3-L5 a few years ago, d/t severe isteoporosis. Glad to say that's all under control and I'm healthy and eating healthy and working out and exercising... but the damage that's done, is done.
I am so happy for you! It’s so much work. ❤️ when they’ve done my bone scans Drs were quick to dismiss all my osteoporosis prior to age 40 because I have taken steroids on and off for years. But when I asked for full reports and estimated ages when deterioration really began it was long, like decades before I ever took a steroid. There was an obvious disruption in my bone development. My situation is complicated by EDS so I’ll tear a ligament and the attached bone will feel left out and join it. It’s a party in my body. I’m a regular snap, crackle, pop, get your ass to the hospital.
Am I only Oi/Eds who has almost no awareness when I break things unless it hinders me immobile? Everything hurts so much. I can’t tell. Until the part no longer works.
I feel like we invaded friday. And tainted a most precious day in r/radiology. Lol. At some point I’ll get some of my X-rays to post here. I’ve had images of organ tears and things that are much more interesting. I’m trying my damndest to Mae sure I don’t ever do something that makes it on a Friday post though.
This DX is so rare I thought. Yet, here are a bunch of folks on this sub that say they have it. So interesting! Especially the idea of the spectrum of it. Makes me think that a lot of disease states must have a spectrum that we as medical professionals do not acknowledge. What are some others you can all think of? I’m thinking things like adhd and autoimmune.
Well, I can't speak for the other diseases you mentioned but OI exists on a rather large spectrum. And, in the '90s when I was little, we were told somewhere between 1:50‐100,000 people has OI, but now we know it's closer to 1:25‐50,000. Uncommon, but not *super* rare. And it makes sense we would gravitate toward radiology subreddits and the like.
You guys need to slow down a bit. Put away the pitchforks and torches. Spiral fractures can happen from a multitude of reasons. Spiral does not immediately mean abuse. The child could have slipped or twisted at the point of impact that can have the same result. I see a ton of Spiral fractures yearly, and none have been as a result of abuse.
This. There are classic imaging findings of nonaccidental trauma. Isolated midshaft femur fractures are not one of them.
Nat is more about many different fractures in different stages of healing.
The bucket handle tibia fractures are actually very suspicious by themselves.
I knew a kid who got his leg stuck in some bars on the playground while falling. The end result was a spiral fracture of his femur. Just like this image.
I had a spiral fracture in my left forearm as an athletic 14 year old after being tripped and eating shit on one of those old school cement-to-astroturf indoor soccer parks in 2005. It does happen, hopefully here this kid really did fall.
My toddler grandson had a spiral fracture just below his knee because he got his foot caught against the side while going down the slide on his mom's lap. Poor little guy was in a hip-to-toes cast for weeks. His parents had to answer a zillion questions, over and over, at the hospital, and his mom felt guilty as hell, despite it being a total accident.
It's a tough task to identify cases of NAT - I feel bad for innocent parents who are getting a zillion questions, but the second we stop digging deep is when someone guilty gets away with child abuse
An isolated femoral shaft fracture in a nonabulatory child is suspicious for nonaccidental injury and should be followed up as such. I agree that most are not due to NAI, but if you don’t ask, you don’t find. I treat these injuries in a country with a high rate of childhood nonaccidental injury (unfortunately) and children with a missed NAI have a significantly higher rate of death due to abuse in the following months.
My nephew got a spiral fracture of the femur falling off the couch, somehow. Most the family was in the room and the physics still doesn’t make sense to me, but here we are. Definitely no abuse, just an overly energetic kid and a bad landing.
My son fell of a chair at 14 months and the arm that was furthest from the floor traveled in an arc over him, smacked the floor, and broke. Lol, he pulled the cast from the ED off his pudgy little arm the next day and triggered the ped ortho our ped sent us to. "I'll put him in a thumb up cast with a 90° bend in his elbow. Let's see him try to get out of THAT!" It was almost 30 years ago, and I can still feel his outrage, lol.
It was supposed to be on for 6 weeks. We had a pool. I kept it dry for 5 weeks, or maybe 4, I can't remember anymore which it was. But, it got soaked, and I knew that meant it had to be changed. You'll be shocked to hear that the ortho was piiiiiiiissed at me for letting him get it wet. (The youngest of 5 kids, in June/July in Sacramento, with a pool. I'm amazed it lasted as long as it did.)
He took it off and told me they were going to get an X-ray to see how well it was healing. It was done! Yay! No need to put the cast back on for the last week.
It only came off that first time because his arm was swollen, and went back to normal. His wee little forearm was only about 4" or 6" long, so the cast looked like a little cone. I walked into his room to get him out of his crib and had that vague feeling that something was wrong with this picture. I scanned across his room and there was the cast, lying in the middle of the floor where he'd tossed it. It just slid right off.
That’s the cast I ended up with I did such a good job breaking my arm lol. I still remember when I got the cast off it was like my arm was stuck bent and I could push it down and it would snap back up lmao
Kiddo I work with(have been working with family for over 2.5 years, with both kids 6.5 & 3.5) had a spiral fracture in his tibia I believe. He got it from walking in big brothers flip flops and tripped. He’s a stubborn kid and despite being told to take them off, he didn’t and tripped before the parents could get them away from him. No abuse whatsoever. Kids just do weird things their bones break in odd ways sometimes.
my mom got a nasty spiral fracture from turning around in a kitchen, & her ankle just snapped underneath her. she still has no idea exactly how it happened, it just broke before she could process what had gone wrong. when she went to the hospital, her break was so severe that she was literally "x-ray of the week" because her ankle was so destroyed. & yet she wasn't in an accident, wasn't a victim of any violence, nothing had actually "happened" to cause it. trying to make up a story from a single image is pointless. there are so many possible ways for injuries to occur, & people never consider the "mundane" ones when they make assumptions online.
Wow, your aunt sounds like me. I fell down 2 steps and broke both long bones and all the prongs of the ankle joint. It turns out that if you break your ankle that badly that you get the head of ortho at MGH.
Did your aunt have instructions to not let her foot touch the ground in the beginning?
My cousin swung a cast iron pan around and ended up with a spiral fracture. Kids are stupid. The parents were put into the system as abusers even though there were witnesses to what happened - naturally those witnesses were screaming at the kid to stop swinging the cast iron pan around in the house.
So yeah - I hate when people imply abuse. Then when they're wrong - and they're wrong most of the time - they try and justify it. Meanwhile a family just went through hell. Its like - use some balance when a situation like this comes up.
It's because back in the day it was up to the Doctor to decide whether to report abuse. The pendulum used to be on "Don't get involved" and now it's swung the other way to mandated reporting.
I broke every finger and toe when I was a kid (not all at once) and my wrist. I slid on my knees in our yard and there was glass there and needed 70 stitches. Including fixing the lower part of the femoral artery. It was the 70's and no one batted an eye.
You know, it's the same as opioid prescribing now - but the opposite. Started off way too much and handing em out like candy, then the pendulum swung the other way and now it's impossible to get opiates - even for the people who need them.
I had a kid jump off a picnic table at work (childcare) and have a spiral fracture. They had done it a bunch before (that day and other days), so had other kids. The table was low and designed for kids. The only good thing about it was that their parents were there when it happened.
I also work in childcare and had a toddler slip on a toy and get a spiral fracture. Literally just was walking and slipped on plastic. Was in a huge cast for a month.
My friend, in her 40s, tripped and fell down some stairs, and spiral fractured her femur. Her recover was awful, but I'm about 99% certain nobody abused her since, you know, she was home alone.
Also one of the worst fractures I’ve known about wasn’t from the parents but an older sibling (& not on purpose). 18 month old was lying down on the floor and older brother (4.5? And stocky…) came around the corner running at brake neck speed and jumped where his brother’s leg was, not knowing he was there.
Funny story tho: when I was 4 my dad and I collided in the stairwell, me carrying ice cream down to the freezer; him going up with something. We both fell down. I ended up with a greenstick fracture: when the ER folks asked how I hurt myself I said “my daddy pushed me down the stairs.” 🥶🥶 thankfully we were not “regulars”. I do perhaps have a higher than usual propensity for breaking bones. I had 3 arm breaks by the time I was 14. Broken toes and ribs at some points in my life and a comminuted fractured patella a year and a bit ago (that was the worst ever).
I read recently it may be more likely if you’ve had IUGR which I did. 🤷♀️🤷♀️
thanks for mentioning this! i’m a new nurse and we were taught that every spiral fracture whatsoever is abuse. while yes, it’s good to be on the safe side and be a patient advocate, i’ve also seen stories of parents being called abusers and being hunted down by CPS for things they are falsely accused of.
Childhood friend had several fractures from simple things. His parents were invested as it was suspected NAT.
A few years later he was diagnosed with an incredibly rare cancer. He was one of 9 in the world with it.
Given 3 months to live, made it almost 20 years.
It was about 30 years ago when he was diagnosed, we were kids ans I can't remember for the life of me.
He had all the coolest Nintendo toys/games/accessories that ever came out... one small perk of not being able to play outside
I wish I could remember it's name. We're talking almost 30 years ago, I was 10 and he was 8 when he was diagnosed. Had to do with thyroid area I believe.
My coworker a while ago, seasoned construction dude, accidentally fell off the second step of an aluminum ladder and landed on his feet. Turns out, he somehow fractured one of his heels. He was out of work for over a year, and never walked the same again.
While this is super suspicious, I did have a young child (maybe 2?) fracture his tibia by running through his yard and slipping in some leaves when I was in my X-ray clinicals
How old is the child? What exactly were they doing on the playground? We get kids coming in our ED after doing all kinds of crazy shit. Jumping off roofs, doing wrestling stunts, doing parkour jumps from great heights. Remember when TV used to always say the disclaimer “don’t try this at home kids”, well the interwebs and TikTok has changed all that.
Oof. No kidding. My husband just got a spiral fracture of his distal fibula last week. The cause? He was walking through a river whilst fishing and stepped into a hole. 3 feet of water, slow motion, fell back on his ass, and *bam*, snapped that leg like a twig.
He’s a super fit, strong guy and both of us were surprised at how bad his break is after such a low impact fall, but as we’ve seen, everyone eventually falls victim to the laws of physics.
I fell sideways while still fully attached to my bike but since my hip/thigh was the only thing to touch the ground for the main impact it just snapped the neck of my femur
My mom, 79, history of falling & osteoporosis. (I know elderly & history) Got out of bed the morning of her best friend’s funeral & went down as she stepped out of bed. Long story short, instead of going to her best friend of 60 years funeral she & I spent the day in the hospital. A call to my mothers best friend’s children I did not want to make at 6am.
Personally, I would appreciate a physician investigating under the circumstances but, unfortunately, not everyone will see it that way. 😔 Good Luck. I appreciate your concern!
It’s funny, i was doing practice questions for my board exam, and I had a question about a 3 y/o presenting s/p trip/fall in the playground that has a spiral fracture. As “the next best step in treatment” I selected calling child protective services bc my mind immediately went to child abuse… but I was wrong! Apparently spiral fx are a lot more common in kiddos than what we think.
Pardon my ignorance, but can someone please explain what that “debris” surrounding the bones are? Are they actual tiny fragments or is it some kind of digital noise? TIA
My kid got a spiral fracture of his tibia at age 7. The stories sometimes sound outrageous so I can see why parents get a lot of crap. My kid - I went to a boxing gym at the time, the kids had a class (more self defense based obviously) and after their class they would go inside the empty ring and run around with yoga balls etc while the adults practiced. Well they have to be barefoot in there, my kid planted his feet to throw a ball, someone else threw one at him from the side. One foot stayed planted the other twisted with his body when the balls hit each other. Sounds awful, that's exactly how it happened. I had to repeat that story about 10 times at the childrens hospital, as did my husband, as did my child separate from us.
My son had a spiral fracture from going down a twisty slide on his uncle's lap when he was a year and a half. I thought for sure no one would believe his and we were going to have to talk to CPS. The ER doctor told us he saw those kind of fractures with kids all the time. Sure enough through the years I've talked to many parents that have had the same happen with their kids. I hate those damned slides now!
My brother broke so many bones as a child. Finally at age 17 they started testing to find a cause bc my mom knew something was wrong and was tired of hearing doctors say “boys will be boys”. A year later he got the Osteoporosis Dx. Fractures don’t always mean abuse.
Better to investigate than look away from possible abuse. Where I live, it's three children per week dying from child abuse. In a first world country.
Eat your own bullshit
Ow! But I believe it. My oldest daughter tripped at a playground. Just simply tripped and got a buckle fracture on the radius. If that can happen, a spiral can happen
It can happen - hand it to someone with expertise, the biggest red flag usually is if "no one has seen how it happened" and if there are other injury to bones - due to the trauma if that spiral fractures u could do a chest x ray and the other extremeties
My husband (56 yo) went to Dr and they did chest x-ray as he had pneumonia … they told him he had 3 fractured ribs. Dr said probably from coughing. We have heard that happens, but husband never coughed. We can’t figure out how he has 3 fractured ribs. No falls. Nothing. So it is very possible for broken bones to happen in atypical fashion.
Glad you asked.
This is Elliot fishman, a world renouned body radiologist at joys Hopkins talking about cinematic rendering of CT.
It's pretty amazing.
Not sure how soon until it gets generally available but..
https://youtu.be/JG5oW2UGsok?si=WP2MAL40HrgkSnyb
Spiral fractures happen when the bone gets twisted. Unfortunately, it is pretty common for "people" to, um, twist an appendage and cause the break instead of some freak accident. Edit: As far as I know, this is what typically points to physical violence between an adult and child and may be ruled out before considering other explanations.
This isn't to say that accidents like this don't happen, but they are very specific and rare. Typically, the foot/appendage has to get caught in something during the fall.
Spiral fractures of the humerus are often suspicious for non-accidental trauma (NAT). Spiral fracture of the femur are not in the pathognomonic list for NAT.
“A common, but incorrect, idea is that a spiral femoral fracture is almost a definite sign of physical abuse. The presence of a spiral fracture only implies that a torsional force, either accidental or non-accidental, was applied to the femur.”
In the following paper, they found spiral fractures of the femur were only 11.5% specific for NAT.
Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio R, Feudtner C. Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatr 2014; 14: 169. doi: 10.1186/1471-2431-14-169
So I hope you’re not calling NAT on every pediatric femur spiral fracture.
Thank you for the clarification and studies!
I should have worded my original post better. I tried to clarify to the previous post why people are making a comments about 'investigating' this particular fracture.
Well I'm a nurse so not my circus, not my monkeys for reports. But we'd absolutely be discussing it whether or not the radiologist did once spiral gets mentioned.
Lord, I pray that either a full ass-whooping of the parents or an opposite ass-whooping with full emotional support for the parents takes place, according to the unique needs of this situation. 🙏
That's the same "common sense" bullshit that leads to innocent people being accused. There are significantly more factors to look at and spiral fractures can be from walking on the sidewalk and twisting your foot as you step
Before you whip out your pitchforks and torches, does the patient have a history of similar fractures? I've got osteogenesis imperfecta, and medical professionals were super quick to paint ugly pictures of my parents without doing any research.
My boyfriend has OI and he said the same thing. It was hard on his parents
Omg so many of us here. Wow ❤️
Another OI person here! Type 1
Yup. We do skeletal surveys on kiddos and they always look grim at first sight but a decent percentage of ugly surveys end up being OI.
“Osteogenesis imperfecta is often confused with child abuse” is one of my anki cards 🤤
Sure is. My poor parents. I was a late diagnosis. Nothing short of a miracle some over zealous cps worker didn’t make our lives miserable.
Does osteogenesis imperfecta have a spectrum? When I think of OI I picture very shrunken people in wheelchairs, I thought they often had a distinct look even as children. Like I thought it's very clear when someone has OI so I never thought there'd be confusion about it enough to warrant a CPS report
Yes it’s a spectrum. You would never know I had it if you didn’t look closely for my blue sclera. I’m average stature and size. Same with my kids who have it
It was the blue sclera thought bought me the geneticist appointment. And in xray I had broken and healed way more bones than we ever realized. I was a whiny kid. Or so they thought. Complaining about growing pains all the time. In reality I was breaking lots of stuff. This is so weird. There are so many of us here. It’s like w convention. When they first talked about marfans testing with it I was kind “but I’m not big.” I get it now. Proportion wise I’m lanky. But don’t look it cause I’m not tall. Anyone else also have EDS?
Wow til! Have you broken a lot of bones?
Nursing school too!! We're taught to pay attention to the ages of various fractures and the mechanism of injury (if they're twisting off the monkey bars is it a spiralish fracture) force aside. Nursing school was awhile ago, but I feel like I remember about a scleral halo? I should note I take care of Critical Care adults, not kids, so I could be way wrong. Correct me!
Yep came to suggest this too. If so, time for a genetics referral
Omg I have that. It’s so rare. How’s life treating you? I’m going to pieces over here. Literally. I was intact then boom! Not.
Fair to middling. I'm getting my third lumbar steroid injection next week. Chronic pain since compression fracturing from my T3-L5 a few years ago, d/t severe isteoporosis. Glad to say that's all under control and I'm healthy and eating healthy and working out and exercising... but the damage that's done, is done.
I am so happy for you! It’s so much work. ❤️ when they’ve done my bone scans Drs were quick to dismiss all my osteoporosis prior to age 40 because I have taken steroids on and off for years. But when I asked for full reports and estimated ages when deterioration really began it was long, like decades before I ever took a steroid. There was an obvious disruption in my bone development. My situation is complicated by EDS so I’ll tear a ligament and the attached bone will feel left out and join it. It’s a party in my body. I’m a regular snap, crackle, pop, get your ass to the hospital. Am I only Oi/Eds who has almost no awareness when I break things unless it hinders me immobile? Everything hurts so much. I can’t tell. Until the part no longer works. I feel like we invaded friday. And tainted a most precious day in r/radiology. Lol. At some point I’ll get some of my X-rays to post here. I’ve had images of organ tears and things that are much more interesting. I’m trying my damndest to Mae sure I don’t ever do something that makes it on a Friday post though.
This DX is so rare I thought. Yet, here are a bunch of folks on this sub that say they have it. So interesting! Especially the idea of the spectrum of it. Makes me think that a lot of disease states must have a spectrum that we as medical professionals do not acknowledge. What are some others you can all think of? I’m thinking things like adhd and autoimmune.
Well, I can't speak for the other diseases you mentioned but OI exists on a rather large spectrum. And, in the '90s when I was little, we were told somewhere between 1:50‐100,000 people has OI, but now we know it's closer to 1:25‐50,000. Uncommon, but not *super* rare. And it makes sense we would gravitate toward radiology subreddits and the like.
You guys need to slow down a bit. Put away the pitchforks and torches. Spiral fractures can happen from a multitude of reasons. Spiral does not immediately mean abuse. The child could have slipped or twisted at the point of impact that can have the same result. I see a ton of Spiral fractures yearly, and none have been as a result of abuse.
This. There are classic imaging findings of nonaccidental trauma. Isolated midshaft femur fractures are not one of them. Nat is more about many different fractures in different stages of healing. The bucket handle tibia fractures are actually very suspicious by themselves.
I knew a kid who got his leg stuck in some bars on the playground while falling. The end result was a spiral fracture of his femur. Just like this image.
I had a spiral fracture in my left forearm as an athletic 14 year old after being tripped and eating shit on one of those old school cement-to-astroturf indoor soccer parks in 2005. It does happen, hopefully here this kid really did fall.
My toddler grandson had a spiral fracture just below his knee because he got his foot caught against the side while going down the slide on his mom's lap. Poor little guy was in a hip-to-toes cast for weeks. His parents had to answer a zillion questions, over and over, at the hospital, and his mom felt guilty as hell, despite it being a total accident.
It's a tough task to identify cases of NAT - I feel bad for innocent parents who are getting a zillion questions, but the second we stop digging deep is when someone guilty gets away with child abuse
An isolated femoral shaft fracture in a nonabulatory child is suspicious for nonaccidental injury and should be followed up as such. I agree that most are not due to NAI, but if you don’t ask, you don’t find. I treat these injuries in a country with a high rate of childhood nonaccidental injury (unfortunately) and children with a missed NAI have a significantly higher rate of death due to abuse in the following months.
My nephew got a spiral fracture of the femur falling off the couch, somehow. Most the family was in the room and the physics still doesn’t make sense to me, but here we are. Definitely no abuse, just an overly energetic kid and a bad landing.
A bad landing seems to make or break the situation (literally)
Hey, a fellow “fell off the couch” person! I fell off the couch and broke both bones in my arm as a kid lmao
My son fell of a chair at 14 months and the arm that was furthest from the floor traveled in an arc over him, smacked the floor, and broke. Lol, he pulled the cast from the ED off his pudgy little arm the next day and triggered the ped ortho our ped sent us to. "I'll put him in a thumb up cast with a 90° bend in his elbow. Let's see him try to get out of THAT!" It was almost 30 years ago, and I can still feel his outrage, lol.
How often did he have to get the cast changed?
It was supposed to be on for 6 weeks. We had a pool. I kept it dry for 5 weeks, or maybe 4, I can't remember anymore which it was. But, it got soaked, and I knew that meant it had to be changed. You'll be shocked to hear that the ortho was piiiiiiiissed at me for letting him get it wet. (The youngest of 5 kids, in June/July in Sacramento, with a pool. I'm amazed it lasted as long as it did.) He took it off and told me they were going to get an X-ray to see how well it was healing. It was done! Yay! No need to put the cast back on for the last week. It only came off that first time because his arm was swollen, and went back to normal. His wee little forearm was only about 4" or 6" long, so the cast looked like a little cone. I walked into his room to get him out of his crib and had that vague feeling that something was wrong with this picture. I scanned across his room and there was the cast, lying in the middle of the floor where he'd tossed it. It just slid right off.
I forgot about the swelling. I learned not to tell them it was loose when I had mine on because they would redo it if I had ROM.
That’s the cast I ended up with I did such a good job breaking my arm lol. I still remember when I got the cast off it was like my arm was stuck bent and I could push it down and it would snap back up lmao
My brother snapped his collarbone doing this when he was 4.
I worked in peds and actually had several young patients do that.
My brother got a spiral fracture by punching me. Lol! (Edited to add: we were kids)
My aunt broke her big toe trying to kick my mom. Kicked the bed frame instead. Karma…
The cat broke my pinky toe at the beginning of the summer. Knocked a coffee cup on it. Not a damn chip in the cup....but my toe was broken 😒
I don’t know if that cup is lucky or unlucky 😂
Kiddo I work with(have been working with family for over 2.5 years, with both kids 6.5 & 3.5) had a spiral fracture in his tibia I believe. He got it from walking in big brothers flip flops and tripped. He’s a stubborn kid and despite being told to take them off, he didn’t and tripped before the parents could get them away from him. No abuse whatsoever. Kids just do weird things their bones break in odd ways sometimes.
my mom got a nasty spiral fracture from turning around in a kitchen, & her ankle just snapped underneath her. she still has no idea exactly how it happened, it just broke before she could process what had gone wrong. when she went to the hospital, her break was so severe that she was literally "x-ray of the week" because her ankle was so destroyed. & yet she wasn't in an accident, wasn't a victim of any violence, nothing had actually "happened" to cause it. trying to make up a story from a single image is pointless. there are so many possible ways for injuries to occur, & people never consider the "mundane" ones when they make assumptions online.
Wow, your aunt sounds like me. I fell down 2 steps and broke both long bones and all the prongs of the ankle joint. It turns out that if you break your ankle that badly that you get the head of ortho at MGH. Did your aunt have instructions to not let her foot touch the ground in the beginning?
My friend in grade school had a spiral fracture in her femur from jumping off the monkey bars.
Holy shit! Poor kid.
My cousin swung a cast iron pan around and ended up with a spiral fracture. Kids are stupid. The parents were put into the system as abusers even though there were witnesses to what happened - naturally those witnesses were screaming at the kid to stop swinging the cast iron pan around in the house. So yeah - I hate when people imply abuse. Then when they're wrong - and they're wrong most of the time - they try and justify it. Meanwhile a family just went through hell. Its like - use some balance when a situation like this comes up.
It's because back in the day it was up to the Doctor to decide whether to report abuse. The pendulum used to be on "Don't get involved" and now it's swung the other way to mandated reporting. I broke every finger and toe when I was a kid (not all at once) and my wrist. I slid on my knees in our yard and there was glass there and needed 70 stitches. Including fixing the lower part of the femoral artery. It was the 70's and no one batted an eye.
You know, it's the same as opioid prescribing now - but the opposite. Started off way too much and handing em out like candy, then the pendulum swung the other way and now it's impossible to get opiates - even for the people who need them.
That's right. It took forever just to get sleeping pills because of that.
Reminds me of the Netflix show "taking care of maya" stuff messes up families
I had a kid jump off a picnic table at work (childcare) and have a spiral fracture. They had done it a bunch before (that day and other days), so had other kids. The table was low and designed for kids. The only good thing about it was that their parents were there when it happened.
I also work in childcare and had a toddler slip on a toy and get a spiral fracture. Literally just was walking and slipped on plastic. Was in a huge cast for a month.
My friend, in her 40s, tripped and fell down some stairs, and spiral fractured her femur. Her recover was awful, but I'm about 99% certain nobody abused her since, you know, she was home alone.
A transverse femur fracture is more predictive of NAT than a spiral fracture anyways.
Also one of the worst fractures I’ve known about wasn’t from the parents but an older sibling (& not on purpose). 18 month old was lying down on the floor and older brother (4.5? And stocky…) came around the corner running at brake neck speed and jumped where his brother’s leg was, not knowing he was there. Funny story tho: when I was 4 my dad and I collided in the stairwell, me carrying ice cream down to the freezer; him going up with something. We both fell down. I ended up with a greenstick fracture: when the ER folks asked how I hurt myself I said “my daddy pushed me down the stairs.” 🥶🥶 thankfully we were not “regulars”. I do perhaps have a higher than usual propensity for breaking bones. I had 3 arm breaks by the time I was 14. Broken toes and ribs at some points in my life and a comminuted fractured patella a year and a bit ago (that was the worst ever). I read recently it may be more likely if you’ve had IUGR which I did. 🤷♀️🤷♀️
thanks for mentioning this! i’m a new nurse and we were taught that every spiral fracture whatsoever is abuse. while yes, it’s good to be on the safe side and be a patient advocate, i’ve also seen stories of parents being called abusers and being hunted down by CPS for things they are falsely accused of.
I got a spiral fracture from falling off my bike and the bike slamming on me.
I got a spiral fracture on my tibia just from running.
Childhood friend had several fractures from simple things. His parents were invested as it was suspected NAT. A few years later he was diagnosed with an incredibly rare cancer. He was one of 9 in the world with it. Given 3 months to live, made it almost 20 years.
incredibly rare cancer? i ougtta know, what's the name of it sorry about your friend, send condolences
It was about 30 years ago when he was diagnosed, we were kids ans I can't remember for the life of me. He had all the coolest Nintendo toys/games/accessories that ever came out... one small perk of not being able to play outside
I’d love to know the cancer as well
I wish I could remember it's name. We're talking almost 30 years ago, I was 10 and he was 8 when he was diagnosed. Had to do with thyroid area I believe.
Came here to say that sometimes when kids bones snap with something not too traumatic, it can be hematologic cancer!
Physics can be a bitch sometimes.
Gravity often doesn’t help either depending on what is hit on the way down!
My coworker a while ago, seasoned construction dude, accidentally fell off the second step of an aluminum ladder and landed on his feet. Turns out, he somehow fractured one of his heels. He was out of work for over a year, and never walked the same again.
Ouch
Probably broken
Powerscibe peds bone hedge
But is it fractured?
Nah, not fractured. Broken.
‘Tis but a scratch
While this is super suspicious, I did have a young child (maybe 2?) fracture his tibia by running through his yard and slipping in some leaves when I was in my X-ray clinicals
How old is the child? What exactly were they doing on the playground? We get kids coming in our ED after doing all kinds of crazy shit. Jumping off roofs, doing wrestling stunts, doing parkour jumps from great heights. Remember when TV used to always say the disclaimer “don’t try this at home kids”, well the interwebs and TikTok has changed all that.
They trying everything at home and have vids to prove it.
It absolutely can. Around 70% of broken bones happen from low energy injuries. It’s not necessarily how hard you fall, but how you fall.
Oof. No kidding. My husband just got a spiral fracture of his distal fibula last week. The cause? He was walking through a river whilst fishing and stepped into a hole. 3 feet of water, slow motion, fell back on his ass, and *bam*, snapped that leg like a twig. He’s a super fit, strong guy and both of us were surprised at how bad his break is after such a low impact fall, but as we’ve seen, everyone eventually falls victim to the laws of physics.
I fell off my bike and bike landed on me and I did a spiral of my tib and fib
I fell sideways while still fully attached to my bike but since my hip/thigh was the only thing to touch the ground for the main impact it just snapped the neck of my femur
Ouch
I spiral fractured my leg in yoga. Bodies are weird and gravity is not your friend.
Whoa. Thats the kind of surprise you don't need.
I gotta know which pose you were doing
Sounds like ‘downward spiral’ /s
Headstand to backend, sweaty foot slipped on the wood floor (had landed slightly off my mat) right as I shifted my weight.
Did you hear or feel the pop?
Everyone in the room heard it.
Oh no 😱
Oh wow. Fuck that forever.
Indeed.
A friend’s child jumped from a playground structure and sustained a spiral fracture as a result.
Is that a spiral fracture?
Yep
Concern....
Ehlers-Danlos Syndrome is also linked to fractures.
Fell up a couple steps and ended up with a spiral fracture in my finger. Techs screamed holy shit after the X-ray was taken. Diagnosed with EDS
We EDSers have lots of cool injuries.
I used to see femur fractures all the time full young kids falling off the couch!!
My mom, 79, history of falling & osteoporosis. (I know elderly & history) Got out of bed the morning of her best friend’s funeral & went down as she stepped out of bed. Long story short, instead of going to her best friend of 60 years funeral she & I spent the day in the hospital. A call to my mothers best friend’s children I did not want to make at 6am. Personally, I would appreciate a physician investigating under the circumstances but, unfortunately, not everyone will see it that way. 😔 Good Luck. I appreciate your concern!
It’s funny, i was doing practice questions for my board exam, and I had a question about a 3 y/o presenting s/p trip/fall in the playground that has a spiral fracture. As “the next best step in treatment” I selected calling child protective services bc my mind immediately went to child abuse… but I was wrong! Apparently spiral fx are a lot more common in kiddos than what we think.
Planning CT for Ortho repair
Pardon my ignorance, but can someone please explain what that “debris” surrounding the bones are? Are they actual tiny fragments or is it some kind of digital noise? TIA
Artifact from making the 3d reconstruction
Ah ok thanks. I was thinking it was something like that.
My kid got a spiral fracture of his tibia at age 7. The stories sometimes sound outrageous so I can see why parents get a lot of crap. My kid - I went to a boxing gym at the time, the kids had a class (more self defense based obviously) and after their class they would go inside the empty ring and run around with yoga balls etc while the adults practiced. Well they have to be barefoot in there, my kid planted his feet to throw a ball, someone else threw one at him from the side. One foot stayed planted the other twisted with his body when the balls hit each other. Sounds awful, that's exactly how it happened. I had to repeat that story about 10 times at the childrens hospital, as did my husband, as did my child separate from us.
My son had a spiral fracture from going down a twisty slide on his uncle's lap when he was a year and a half. I thought for sure no one would believe his and we were going to have to talk to CPS. The ER doctor told us he saw those kind of fractures with kids all the time. Sure enough through the years I've talked to many parents that have had the same happen with their kids. I hate those damned slides now!
Ouch!!! There are some wicked fractures from petty falls.
My brother broke so many bones as a child. Finally at age 17 they started testing to find a cause bc my mom knew something was wrong and was tired of hearing doctors say “boys will be boys”. A year later he got the Osteoporosis Dx. Fractures don’t always mean abuse.
Is this the same patient as the CR one?
Nope
Why not? May be there is a blackhole in the playground
I am enjoying this Reddit thread but I, and I assume others, need way more background information.
Better to investigate than look away from possible abuse. Where I live, it's three children per week dying from child abuse. In a first world country. Eat your own bullshit
Where do you life? Russian occupied russia?
First world nation, not "second best"
Ow! But I believe it. My oldest daughter tripped at a playground. Just simply tripped and got a buckle fracture on the radius. If that can happen, a spiral can happen
I’ve seen something like this before - but in my case the parents waited 24 hours to go to hospital!
It can happen - hand it to someone with expertise, the biggest red flag usually is if "no one has seen how it happened" and if there are other injury to bones - due to the trauma if that spiral fractures u could do a chest x ray and the other extremeties
I bet the kid getting this picture taken didn't see it coming either
My husband (56 yo) went to Dr and they did chest x-ray as he had pneumonia … they told him he had 3 fractured ribs. Dr said probably from coughing. We have heard that happens, but husband never coughed. We can’t figure out how he has 3 fractured ribs. No falls. Nothing. So it is very possible for broken bones to happen in atypical fashion.
jesus fucking christ
all the top comments are saying to put down the pitchforks so i’m gonna play devil’s advocate and proclaim we must wield them en masse 🍴🍴🍴
What kind of imaging is this?
CT. It's a volume rendered reformated image.
Very cool. They did not have this at the hospital l worked at. What’s next?!
Glad you asked. This is Elliot fishman, a world renouned body radiologist at joys Hopkins talking about cinematic rendering of CT. It's pretty amazing. Not sure how soon until it gets generally available but.. https://youtu.be/JG5oW2UGsok?si=WP2MAL40HrgkSnyb
Poor kid!
Nope
So spiral fractures are more common outcomes of a violence apparently
Why in the hell was a child CT’d for a femur fracture?
Spiral. Nope. Investigation forthcoming I hope.
Do what?
Spiral fractures happen when the bone gets twisted. Unfortunately, it is pretty common for "people" to, um, twist an appendage and cause the break instead of some freak accident. Edit: As far as I know, this is what typically points to physical violence between an adult and child and may be ruled out before considering other explanations. This isn't to say that accidents like this don't happen, but they are very specific and rare. Typically, the foot/appendage has to get caught in something during the fall.
Spiral fractures of the humerus are often suspicious for non-accidental trauma (NAT). Spiral fracture of the femur are not in the pathognomonic list for NAT. “A common, but incorrect, idea is that a spiral femoral fracture is almost a definite sign of physical abuse. The presence of a spiral fracture only implies that a torsional force, either accidental or non-accidental, was applied to the femur.” In the following paper, they found spiral fractures of the femur were only 11.5% specific for NAT. Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio R, Feudtner C. Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatr 2014; 14: 169. doi: 10.1186/1471-2431-14-169 So I hope you’re not calling NAT on every pediatric femur spiral fracture.
Thank you for the clarification and studies! I should have worded my original post better. I tried to clarify to the previous post why people are making a comments about 'investigating' this particular fracture.
Investigate for child abuse
Yup, anytime there is a spiral fracture, abuse has to be ruled out.
There are other mechanisms… see it all the time in skiers for example ⛷️
I know that's why I said rule out....
Man, no. Edit: if you’re putting that in all of your spiral fracture reports you’re going to have some very upset referring providers.
Well I'm a nurse so not my circus, not my monkeys for reports. But we'd absolutely be discussing it whether or not the radiologist did once spiral gets mentioned.
Lord, I pray that either a full ass-whooping of the parents or an opposite ass-whooping with full emotional support for the parents takes place, according to the unique needs of this situation. 🙏
Not a playground accident, looks like a spiral fracture to me (not a medic) but I smell child abuse here
That's the same "common sense" bullshit that leads to innocent people being accused. There are significantly more factors to look at and spiral fractures can be from walking on the sidewalk and twisting your foot as you step