Introduction

The identification of trauma in non-adult skeletons is rare compared to the rates recorded in adult samples. One of the main reasons for this is that fractures behave differently in children. It seems unlikely that children did not suffer injury in the past, but the nature of immature bone and rapid repair can mask the subtle changes, meaning that rates of non-adult trauma in the past are almost certainly an underestimate. Today, the most common forms of injury in the child are due to motor vehicle accidents, accidental falls (5–10-year-olds), intentional abuse (infants) and recreational sports injuries (adolescents). In the past, child's play, apprenticeships, warfare and physical abuse all exposed children to trauma and, although the mechanisms behind skeletal injuries may have changed over time, the nature of paediatric bone and its reaction to trauma has not.

Properties of paediatric trauma

The size of a child makes it vulnerable to serious injury in any collision; a moving vehicle (car, cart) will hit a small child in the chest or pelvis, as opposed to the lower legs of an adult. A child is lighter, and more likely to become a projectile, sustaining further injury when it hits the ground. The skeletal structure of a child will also influence the severity of injury. The highly cartilaginous and hence plastic nature of paediatric bone means it is less able to protect the vital organs before fracture.