PAEDIATRIC Radiological features of healing in newborn clavicular fractures Michael Fadell 1 & Angie Miller 1 & Laszlo Trefan 2 & Jason Weinman 1 & Jaime Stewart 1 & Kari Hayes 1 & Sabine Maguire 3 Received: 9 July 2015 /Revised: 1 April 2016 /Accepted: 22 August 2016 # European Society of Radiology 2016 Abstract Objectives Given the frequency of abusive fractures among infants, and the lack of research and or evidence for the phases of fracture healing seen in this age group, this study aims to describe a timetable of radiological features of fracture healing among infants in the first months of life. Methods We completed a retrospective cross-sectional time- series study of birth-related clavicle fractures from 2006– 2013. A total of 108 digital images were available for review from 61 infants. The presence or absence of four features of healing including periosteal reaction, callus formation, bridg- ing callus and remodelling were scored by three radiologists. Results The level of agreement between the radiologists was good to high (0.60–0.90). Features of healing were first seen at 7 days (periosteal reaction), 11 days (callus), 20 days (bridging) and 35 days (remodelling), respectively. The peak periods that each feature was present are as follows: periosteal reaction 11–42 days, callus 12–61 days, bridging 22–63 days and remodelling 49–59 days. Conclusions Birth-associated clavicle fractures in infants fol- low a logical progression of healing changes. Understanding the expected progression and timing of fracture healing may be helpful as it pertains to the timing of injury in cases of abuse in infants. Key points • Large study describing the time frames of fracture healing in young infants. • Features of fracture healing develop in a logical progression. • Evidence provided for determining fractures are consistent with a proposed time frame. • It is of critical importance to have sound evidence for the dating of fractures. Keywords Clavicle . Abuse . Non-accidental trauma . Healing fracture . Fracture healing Introduction Fractures are a common manifestation of physical child abuse, and when present can have considerable bearing on the legal process. Multiple fractures of different ages, without a plausi- ble history, are regarded as a hallmark of physical abuse. Although the timing of skeletal injury and healing is of great * Michael Fadell michael.fadell@childrenscolorado.org Angie Miller angie.miller@childrenscolorado.org Laszlo Trefan trefanl@cardiff.ac.uk Jason Weinman jason.weinman@childrenscolorado.org Jaime Stewart Jaime.Stewart@childrenscolorado.org Kari Hayes Kari.hayes@childrenscolorado.org Sabine Maguire sabinemaguire@gmail.com 1 Children’ s Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B125, Aurora, CO 80045, USA 2 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF 144YS, UK 3 Early Years Research Program, Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF 144YS, UK Eur Radiol DOI 10.1007/s00330-016-4569-y