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A baby 11 months old has 1 femur fracture and 1 tibia

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fracture on the right leg,1...
A baby 11 months old has 1 femur fracture and 1 tibia fracture on the right leg,1 tibia fracture on the left leg,all of the fractures are incomplete.The fractures are probably caused by either a direct blow or impact or indirect axial loading of the limb by falling from a height onto the feet with the legs in extension.
The baby fell from the kitchen working surface on the hard floor,what is the mechanism can cause these 3 fractures at the same time?(How dose she fall can cause these 3 fractures at the same time?)
Submitted: 1 month ago.Category: Orthopedics
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Answered in 10 minutes by:
3/8/2018
Orthopedist: Richard Han, Board Certified MD replied 1 month ago
Richard Han
Richard Han, Board Certified MD
Category: Orthopedics
Satisfied Customers: 964
Experience: Physican with over 15 years experience
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Hello my name is***** am a board-certified pediatrician with over 15 years of clinical experience and I am happy to help you. From all the radiographs you've attached, the fractures all appear to be either buckling of the periosteum (the hard outer thin layer of bone forming the silhouette of the bone shape) and crush type injuries to the epiphyseal plates. (growth plate, or cartilaginous areas toward the end of the bones where growth occurs) These can all be explained by what you wrote above, "indirect axial loading of the limb by falling from a height onto the feet with the legs in extension", i.e. falling from a significant height onto the feet with the legs in full extension.

Can I answer anything else for you?

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Customer reply replied 1 month ago
Dear Dr Richard,The baby fell onto the hard floor by the feet first,and then the knees on the floor,but the head didn't knock the floor,when the carer picked her up,she looked like very sleepy without crying.Do you think she was being shock after suffering fractutes?Can the baby being shock by extreme pain because of the fractures,no need to knock the head to being shock?If she was shock,how long(how many minutes) will she wake up and start crying?
Orthopedist: Richard Han, Board Certified MD replied 1 month ago

Hello again. For an 11 month old baby to have fallen on to a hard floor surface enough to sustain multiple fractures and not cry at all but appear sleepy is very unusual. By "shock" if you are using the term colloquially as in 'surprised' or 'bewildered,' an 11 month old is capable of that. With no head trauma, the only other thing that comes to my mind is that the baby is not actually experiencing any pain and is just registering the fall as "matter-of-fact" and is just tired because it's time for the baby to sleep. I wonder if the baby could have an underlying disorder where he either doesn't sense pain or the fall was not very serious and his bones are easily broken such as in a condition called osteogenesis perfecta. Those are my thoughts. Anything else I can help with?

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Customer reply replied 1 month ago
Dear Dr Richard,
Thank you so much for your quick reply.
1.Please describe the mechanism of falling off the kitchen working surface on the hard floor would probably result in these 3 fractures.
2.The baby was picked up immediately after falling off from the kitchen working surface,she didn't knock her head,just looked very sleeply and didn't cry,the carer put her into the bouncer,but she started crying loudly when she was in the baby bouncer.In your opinion,do you think she was dizzy(faint) after suffering 3 fractures?
Orthopedist: Richard Han, Board Certified MD replied 1 month ago
1. The mechanism of injury that would account for the fractures would be what is referred to as a “buckling.” Consider taking a cardboard tube, such as one found inside a roll of paper towel. Now imagine falling down with your. Kay weight onto the tube held longitudinally. The force upon one end of the cardboard tube would cause the tube to buckle or telescope in on itself. That is what would happen to a toddler’s bones falling from a sufficient height onto feet with outstretched legs.
2. In my opinion I don’t think the child was dizzy or faint after suffering the fractures but felt the pain of them while trying to bear weight in the baby bouncer, causing her to cry.
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Customer reply replied 1 month ago
Dear Dr Richard,
Thank you so much for your quick reply.
1.Please check the attached photos to show how the baby fell from the kitchen working surface,does this mechanism would probably result in these 3 fractures?
2.I have checked some medical documents on the internet,some doctors say in some cases,when the baby fall,concussion may occur even if the fall doesn't involve a bump in the head,the baby looks sleepy and doesn't show the pain by crying straight away is because the substance in his body that made him feel the ache was not released yet.In your opinion,do you think that's probable?
Orthopedist: Richard Han, Board Certified MD replied 1 month ago

You're welcome. 1. Yes, the mechanism depicted could explain the three fractures, as it involves stress weight bearing, a torisonal or twisting component, and them a slamming down on both knees. 2.Yes, theoretically concussion can occur in this infant without direct head trauma, as the fall could result in the brain sustaining was is known as coup and contra-coup injury, i.e. when the baby hit the floor, the brain which essentially floats in fluid inside the skulls, slams into the floor of the skull with the sudden deceleration of the body stopping against the floor, then rebounds and hits the top of the skull sustaining blunt trauma on both bottom and top of the brain. This could theoretically "stun" the baby, making him appear dazed and sleeping momentarily, until the pain triggered by weight bearing in the bouncer then caused him to cry.

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Customer reply replied 1 month ago
Dear Dr Han,Which fracture is the most minor one?
Customer reply replied 1 month ago
Hello,Dr Han,are you there?
Orthopedist: Richard Han, Board Certified MD replied 1 month ago

Yes, I'm still here. 5.png and 6.png which i believe are showing two different views of the same fracture, look to be the least serious of the fractures.

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