Incorrect postulate regarding humeral fractures in non-ambulant infants
Incorrect postulate regarding humeral fractures in non-ambulant infants
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关于非活动婴儿肱骨骨折的错误假设
作者：
Norell Rosado
先生，我怀着极大的兴趣和好奇心读了萨默斯等人的文章。他们文章的目的是“调查一个被广泛接受的观点，即在没有外界干预的情况下，一个行动能力有限的婴儿无法通过自己的行动维持肱骨骨折。”作者引用了Hymel和Jenny b[2]的病例报告，一个5个月大的婴儿被3岁的兄弟姐妹碾压后肱骨骨折。然后，作者描述了7例孤立的肱骨骨折归因于儿童在该手臂上翻滚。我不认为人们可以将Hymel和Jenny b[2]的病例报告与Somers等人b[1]中描述的7例病例进行比较，并假设在没有外部干预的情况下滚动会导致非活动婴儿的孤立性肱骨骨折，因为后者报告中的病例都没有外部干预。了解影响长骨骨折的内在和外在因素是至关重要的。虽然Somers等人考虑了许多骨骼的内在因素，但他们完全忽略了最重要的外在因素：骨骼失效（骨折）所需的力（能量）。萨默斯等人描述的婴儿中没有一个会爬，其中两个刚刚开始翻身或试图翻身。婴儿在很小的时候不能翻身的主要原因是他们缺乏必要的力量来推动自己的体重来对抗重力。一个婴儿几乎无法承受自身的重力，不可能有足够的力量来克服像肱骨这样的长骨的失效点。萨默斯等人说，在整个过程中，所有的护理人员都提供了相同的病史。然而，在四个病例中，骨折时只有一个成年人在场。他们还提到，没有发现其他骨折或任何其他重大伤害来支持非意外伤害的诊断。大多数被诊断为非意外伤害的儿童没有其他骨折或重大伤害。因此，在没有分析所有影响骨折的因素的情况下，假设行动能力有限的婴儿可以在没有外界干预的情况下折断长骨，在我看来是不正确的。
Sir, I read with great interest and curiosity the article by Somers et al. [1]. The objective of their article was “to investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party.” The authors cite a case report by Hymel and Jenny [2] of a 5month-old who sustained a humerus fracture after being rolled by a 3-year-old sibling. Then, the authors describe seven cases where isolated humerus fractures were attributed to the children rolling over that arm. I do not believe one can compare the case report by Hymel and Jenny [2] with the seven cases described in Somers et al. [1] and postulate that rolling without the intervention of an external party can cause isolated humerus fractures in non-ambulatory infants, since none of the cases in the latter report had the intervention of an external party. It is crucial to understand the intrinsic and extrinsic factors that affect long bone fractures [3].While Somers et al. [1] took into account many of the bone intrinsic factors, they completely disregarded the most important extrinsic factor: the force (energy) required for a bone to fail (fracture). None of the infants described by Somers et al. [1] was crawling and two of them had just begun rolling over or attempting to roll over. The main reason infants cannot roll over at a young age is that they lack the necessary strength to push their weight against gravity. It is very unlikely that an infant who can barely push their own weight against gravity could have enough strength to overcome the failure point of a long bone, such as the humerus. Somers et al. [1] state that all the caregivers gave the same history consistently throughout the proceedings. However, in four cases, only one adult was present at the time of the fracture. They also mention that there were no other fractures detected or any other significant injuries to support a diagnosis of nonaccidental injury. Most children diagnosed with non-accidental injury do not have other fractures or significant injuries [4]. Therefore, to postulate the idea that infants with limited mobility can fracture a long bone in the absence of the intervention of an external party without analyzing all factors that affect bone fractures is, to my belief, incorrect.