Correspondence (letter to the editor): Little Significance

In the review by Berthold et al. (1) on childhood fractures, abuse is described as a potential cause. Altogether 86 full-text articles were analyzed, but only 40 references and 7 eReferences were listed. Unfortunately, the authors do not provide a critical and differentiated discussion of the various studies, but only use these articles to make primarily statistical statements about how likely it is that a specific type of fracture is the result of abuse. Consequently, the content of this review is of little significance for physicians actively involved in child protection. On the individual case level it is not helpful to know how often e.g. a humeral fracture is caused by abuse.

This also implies that—independent of a statistical analysis—all further information about individual fractures does not offer new insights. To the contrary, especially in the “Biomechanical aspects” section, specific fracture types are described sketchily or not at all, so that more questions are raised than answered.

As a matter of fact, the “Biomechanical aspects” section contains little biomechanical content. No associations between the type and/or magnitude of the mechanical impact and the presentation of the injury, but epidemiological data, such as the frequency of a suspected abuse-related etiology, is provided for fractures of various bones. The latter, however, does not allow to verify the plausibility of a claimed mechanism of injury, but this verification is required for each individual case encountered in clinical practice.