Fractures in Infants

31 Dec

All broken bones are fractures, but there are several types of fractures and different types of fractures require different healing techniques and healing times:

  • Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination.
  • Simple fractures are fractures that only occur along one line, splitting the bone into two pieces, while multi-fragmentary fractures involve the bone splitting into multiple pieces. A simple, closed fracture is much easier to treat and has a much better prognosis than an open, contaminated fracture. Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.
  • Another type of bone fracture is a compression fracture. An example of a compression fracture is when the front portion of a vertebra in the spine collapses due to osteporosis, a medical condition which causes bones to become brittle and susceptible to fracture (with or without trauma).

Other types of fracture are:

  • Complete Fracture: A fracture in which bone fragments separate completely.
  • Incomplete Fracture: A fracture in which the bone fragments are still partially joined.
  • Linear Fracture: A fracture that is parallel to the bone’s long axis.
  • Transverse Fracture: A fracture that is at a right angle to the bone’s long axis.
  • Oblique Fracture: A fracture that is diagonal to a bone’s long axis.
  • Compression Fracture: A fracture that usually occurs in the vertebrae.
  • Spiral Fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted Fracture: A fracture causing many fragments.
  • Compacted Fracture: A fracture caused when bone fragments are driven into each other.
  • Open Fracture: A fracture when the bone reaches the skin.

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring white blood cells to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen’s rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial “woven” bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature “lamellar” bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.

Source: Wikipedia

The coroner’s report states that London Marie Sherwood “also had multiple healing rib fractures” and Joshua “demonstrated or described instances where he struck London’s head on the bedroom wall and another when she slipped out of his hands and hit her head on the bathtub. He also showed how he had shaken London by the legs.” My point is that is is POSSIBLE that London Marie’s injuries could have been sustained within hours or days of Joshua taking custody since the fractures were partially healed and infants heal quicker than adults; it is just as POSSIBLE that London Marie’s injuries could have been sustained within hours or days prior to Joshua taking custody. That is why investigations are ongoing at this time. “[I]t is still unclear whether London suffered the fractures while in Schaak’s care. That part of the investigation continues, Hillstead said.”


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