Childhood trauma: Methods for the identification of physeal fractures in nonadult skeletal remains

Abstract

OBJECTIVES: Today, fractures at the growth plate (or physis) are common injuries in children, but provide challenges of identification in skeletonized remains. Clinical studies provide detailed information on the mechanisms, locations, age of occurrence, and complications associated with physeal fractures, enabling the development of new criteria for identifying this injury in nonadults. To test these criteria, skeletal remains from five rural and urban medieval cemeteries were examined. METHODS: The sample consisted of 961 skeletons (0-17 years) with open epiphyses. Macroscopic observation looked for any irregularities of the metaphysis or epiphysis, which was consistent with the clinical appearance of physeal fractures or resulting complications. Radiographic examination was applied to identify fracture lines or early growth arrest. RESULTS: This study revealed 12 cases of physeal trauma (1.2%). Physeal fractures occurred predominantly at the distal end (75%), and while they were identified in all age categories, they were most frequent in those aged 12-17 years (0.2% TPR). The humerus was the most commonly affected location (3/12 or 25%). CONCLUSIONS: This study highlights the potential for recognizing physeal fractures in children of all ages, enhancing our understanding of nonadult trauma, and enabling us to assign a more precise age of the injury to build up a picture of their activities in the past.

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