Letters

Bruising associated with paediatric fractures

Each case should be treated individually

EDITORI am concerned that a letter I wrote in 1987 has been misquoted in Mathew et al's article. ^{1 2} They attribute to me the assertion that "the force needed to fracture a normal bone is thought to result invariably in external evidence of trauma."² At no time have I made such a statement. What the letter actually said (in relation to infants with large numbers of fractures) was that "there was remarkably little clinical evidence of the trauma that would have been needed had the bones been normal."

The presence or absence of external evidence of trauma is a factor that should contribute to the assessment of the cause of fractures in a child. The lack of bruising or other evidence of trauma is a more significant pointer to a disorder of bone when the fractures are transverse (implying local force), recent, and multiple. To this can now be added the insight of Mathew et al, that displaced fractures are more likely to be accompanied by bruising than are undisplaced ones. Each patient needs to be considered individually for evidence of accidental injury, non-accidental injury, and bone disorder.

Colin Paterson, Reader in medicine. 
Department of Medicine, University of Dundee, Dundee DD1 4HN

1. Paterson CR. Child abuse or copper deficiency? BMJ 1987; 295: 213.
2. Mathew MO, Ramamohan N, Bennet GC. Importance of bruising associated with paediatric fractures: prospective observational study. BMJ 1998; 317: 1117-1118[Free Full Text]. (24 October.)