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The Informed Parent

Questions & Answers: Fractures; Vaccinations

by Louis P. Theriot, M.D., F.A.A.P.
Published on Dec. 01, 1997

Q: My daughter was roller-blading and fell forward hurting her wrist. She was in a lot of pain, and her wrist started to swell immediately. I took her to an emergency room and it was x-rayed. The doctor said he did not see a fracture on the x-ray, but he thought she had a "hairline fracture". He put her in a splint, and told me to have it x-rayed in a week, that she probably needed a cast. I was too frazzled to ask him at the time, but why couldn't he tell me right then if she DID have a fracture, since he was so sure that she did?

A: From the information you have given me, it sounds as if the doctor treated your daughter appropriately. Let me explain why this is so. When one breaks a bone, it heals itself by laying down a bridge of new bone over the fracture. This is called a "callus". It takes around 4-6 weeks for a bone to completely heal itself. The callus however, can be seen forming as early as 7-10 days on the x-ray.

Bone has an inner table, and an outer table. When one fractures a bone that is visible on the initial x-ray, there is a disruption of both the inner and outer tables of the bone. This appears as a crack or a line on the x-ray. When one sustains a "hairline fracture", only the outer table has been disrupted. This is NOT visible on the initial x-ray. After a week or so, when the bone starts to lay down the callus, the changes are then evident on the x-ray. With hairline fractures it can be dramatic to compare the initial x-rays which look normal--to the x-rays 10 days later. The fracture just "jumps out at you".

In your daughter's case, it sounds as if the x-rays appeared normal, but clinically the doctor thought she might have had a fracture. Only time will tell. He did the correct thing in immobilizing the wrist to protect it until a definitive follow-up x-ray can determine if a fracture occurred. If, on the other hand, the repeat x-ray IS normal, then she didn't fracture the wrist, and she will not need a cast for 4-6 weeks. Certainly this would be preferable.

Q:My friend told me that she read an article that said that there have been reports of children losing their hair after receiving vaccinations. This sounds awful. Is it true?

A: A recent study by the Food and Drug Administration, the Center for Disease Control and Prevention, and the Vaccine Adverse Events Reporting System identified 60 cases of hair loss following immunizations since 1984. This was published in JAMA (1997: 278: 1176-1178). The ages of the patients ranged from 2 months to 67 years, and there was a greater incidence in females. Of the 60 cases, 47 were reported to have occurred after the Hepatitis B vaccine.

The exact cause of this phenomena is unclear. Studies are ongoing to try to determine if this is from something in the vaccine itself, or if it has to do with the person's immune system.

60 cases over a 13 year period hardly warrants drastic measures regarding the current immunization policy in the United States. When one considers that the average 5 year old entering kindergarten has received 17 vaccines, multiply that by the number of children in the country, millions of vaccines are given annually. Are these 60 cases an aberration, do they have to do with the individual's immune system, or are they directly related to the vaccines themselves? Until we have the absolute answer, it would be prudent to reserve comment. We simply need all the facts. Clearly, no one can dispute the overwhelming benefits and success of the vaccines in preventing and eradicating the ravages of Diptheria, Tetanus, Pertussis, Polio, Measles, Mumps, Rubella, Hemophilus Influenza (once the most common type of meningitis in children), Hepatitis B and Chicken pox.

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