AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

ABSTRACTS

BOOK OF ABSTRACT OF THE 49TH ANNUAL GENERAL MEETING/SCIENTIFIC CONFERENCE OF THE ASSOCIATION OF RESIDENT DOCTORS, UNIVERSITY COLLEGE HOSPITAL, IBADAN

Theme: Non-communicable diseases in Nigeria: Where do we stand?

Sub-themes: 1. Re-emergence of massive brain drain in the Nigeria Health Sector: Making the Residency training an instrument of change 2. Life out of House job/Residency options

Date: 3 - 10th Dec., 2017

Oral Presentations S001: PATTERN OF ACCIDENTAL FEMUR FRACTURES IN CHILDREN AND THE PREDICTORS OF CHILD ABUSE IN AN URBAN COMMUNITY IN NIGERIA

Adeyemi, O.J.1 , Oyetunde, O.2

  1. Department of Surgery, University College Hospital, Ibadan
  2. Emergency Department, University College Hospital, Ibadan

Introduction: Investigating physical abuse in children in Nigeria is not a routine practice. Unlike other climes where there is an established team that intervenes in cases of child abuse and neglect, no such practice is done in Nigeria. But child abuse does exist. Such children are difficult to identify from other children with accidental fractures. The code of silence is also obeyed as the child, if able to vocalize, will refrain from talking, having been sternly warned by caregivers. This study seeks, within the ambit of the history, examination and radiologic characteristics of the femur fractures, predict the possibility of child abuse.

Objectives: The aim of the study is to describe and analyze the pattern of accidental femur fractures in children and to predict the occurrences of child abuse in an urban community in Nigeria.

Methods: A retrospective study was conducted using the Accident and Emergency records of the University College Hospital, Ibadan, Nigeria over a period of ten years (January 2006 – December 2015. 87 cases were retrieved. Selected cases were children between the ages of 0 and 15 that sustained at least a femur fracture. Demographic data, aetiologies of fractures, and X-Ray features of the different cases were collated and analyzed.

Results: Of the 87 cases aged between 0 – 15 years, 52 were males while 32 were females and 41.4% of the cases were between the ages of 2 -5 years. Of the assessed etiologies for femur fractures, 32.3% of the cases occurred following fall from heights and this was followed by pedestrian road traffic accident (17.2%). The morbidities recorded were fever, wound sepsis and anaemia. Femur shaft was the commonest region of fracture and the patterns of fracture noted were majorly transverse fracture (37.9%), oblique fracture (27.6%), and spiral fracture (18.4%). 5.7% of the cases had fractures in other parts of the body. Of all the fracture patterns, spiral fracture pattern is the only one that has a significant relationship with a morbidity – wound sepsis. Also, spiral fractures tend to be seen more commonly as isolated fractures (87.5%) although this observed relationship is not statistically significant. Furthermore, spiral fractures are 1.2times likely to result from domestic accident; however this observed relationship is not significant.

Conclusion: Fall from height and pedestrian road traffic accident remain the highest causes of femur fractures in children. The presence of spiral fracture either occurring in isolation or coexisting with wound sepsis or history of domestic violence should raise a high index of suspicion of a possible child abuse.

Keywords: Child abuse, spiral fractures, trauma, wound sepsis

Correspondence

Adeyemi O.J.

Department of Surgery,

University College Hospital,

Ibadan.