Differentiating Abuse from Accident in Young Children with Osteogenesis Imperfecta: Biomechanical Assessment of Fracture Risk

Fractures are common in children, resulting from both accidents and physical abuse. Distinguishing between injuries that are accidental or non-accidental in nature is crucial in determining whether a child abuse investigation is warranted and whether removing a child from their home is needed. If not removed, an abused child could incur further injuries or even death if abuse was missed. Making the distinction between accident and abuse can be further complicated in children with bone disorders such as osteogenesis imperfecta (01), a genetic bone fragility disease, which can lead to many more fractures in childhood compared to healthy children. For instance, femur fractures are both a common indication for suspicion of abuse and a common fracture site for those with 01. In medico-legal cases involving child abuse, an on-going controversy is whether multiple fractures in children are attributed to bone disorders, such as 01, or abuse. A rigorous biomechanical analysis can help to address this controversy through determining compatibility of history, fracture characteristics, and bone health status which is critical to assure accuracy in clinical and forensic decision making. The field is currently lacking an assessment of biomechanical compatibility of fracture with common activities in infants and toddlers, a particularly vulnerable population for abusive fractures. The goal of this project is to characterize the risk of fracture in young children with 01 compared to that of healthy children when exposed to loading associated with common activities (e.g. walking and jumping). First, motion analysis of gait and jumping in young children (aged 8-24 months old) will be conducted to characterize joint loading applied to the femur, a common fracture location in children with 01. The femur loading will then be applied to 3D computer models of healthy femurs and those affected by 01 to determine fracture risk associated with walking. Femur models will be derived from imaging of healthy bone and bone affected by 01 collected as a part of a previous study. A previously developed statistical shape model of healthy infant femurs will be used to provide age-matched controls to the 01 femur models. Fracture risk will be determined using finite element analysis applied to the 3D computer models of the healthy femur and femur affected by 01 due to common activities, such as walking.

Note: This project contains a research and/or development component, as defined in applicable law," and complies with Part 200 Uniform Requirements - 2 CFR 200.210(a)(14). CA/NCF