Fractures in the first year of life. A diagnostic dilemma.

Thirty-four patients with 55 fractures in the first year of life were studied. There were 189 patients with 21 skull fractures and 16 patients with 19 extremity fractures. Extremity fractures occurred at a significantly younger age than did skull fractures. Cause was defined as accidental in 15 patients (44%) and nonaccidental (child abuse) in 19 patients (56%), representing a greater incidence of accidental cause than previous reports indicated in this age group. There were no significant differences between the two groups with regard to mean age, percentage of girls, number of fractures per patient, and distribution of fractures. Eight patients had notable constitutional abnormalities contributing to the causes of their fractures. There was no difference between this group and normal patients with regard to mean age, percentage of girls, distribution of fractures, and number of fractures per patient.