Unintentional Injury

The vast majority of unintentional injuries in children are caused by blunt trauma, in which the force applied to the tissue exceeds the strength of the tissue, resulting in injury. Skin and soft tissue can withstand a significant amount of direct force (such as a child struck by a car) with minimal damage, even though the underlying bone fractures. On the other hand, skin can sustain significant damage from a friction injury, even though the underlying bones may be unharmed. In some injury situations (e.g., when a child's leg is run over by a car), a combination of shearing (friction) and direct force can cause both severe soft tissue injury and fracture.

The leading causes of injury death in the Children's Hospital Trauma Registry are pedestrian-motor vehicle collisions, assaults, and motor vehicle crashes. Each of these mechanisms can cause injury to the lower extremity.

Table 2

Total Lower Extremity Fractures, Open Wounds, and Traumatic Amputations at the Columbus, OH, Children's Hospital Trauma Registry: 1998-2002

Lower Extremity Fractures:

Femur 507

Tibia/Fibula 387

Ankle/Foot/Toes 207

Other/Multiple 2

Total 1103

Open Wounds:

Hip/Thigh 39

Knee/Leg/Ankle 122

Foot 72

Toe 16

Other/Multiple 3

Total 252

Amputations:

Toe/Foot 14

Leg 3

Total 17

A total of 253 motor vehicle-related lower extremity injuries occurred, including 101 in which the patient had been restrained by seat belt, 120 in which the patient had not been restrained by seat belt, and 32 cases in which the use of seat belts was not documented or unknown.

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