No cause for tying hypermobility, EDS to unexplained fractures: Study

Conditions often raised in cases where there is a concern for physical abuse

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Four children hold hands as they stand side by side, with one in a wheelchair.

About every third child with Ehlers-Danlos syndrome (EDS) and every fourth with generalized joint hypermobility at a clinic in Canada had one or more bone fractures, but none had occurred in the first year of life, a study finds.

Most fractures were in the limbs as the result of a known injury, which dispelled concerns that the diseases could be raised in legal cases as reasons for unexplained fractures in infants who were suspected of being abused.

“This has important implications in the child welfare and legal setting,” the researchers wrote in “Fracture prevalence in children diagnosed with Ehlers-Danlos Syndrome and Generalized Joint Hypermobility,” which was published in Child Abuse & Neglect.

Both EDS and generalized joint hypermobility are connective tissue diseases that manifest as overly elastic skin and joints that stretch farther than normal. While bone fractures can occur, they’re not a criterion for diagnosis.

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Fractures in EDS, joint hypermobility

“Despite this, EDS and hypermobility continue to be raised in the legal setting as possible causes of unexplained fractures in infants where there is a concern for physical abuse,” wrote researchers from the University of Toronto and the Hospital for Sick Children in Canada who looked at how common fractures are and their characteristics in children younger than 18 who had a diagnosis of EDS or generalized joint hypermobility.

Out of 26 children with EDS, nine (six boys, three girls) had a reported fracture. There were 15 fractures total, with the earliest occurring at age 2 in three children that affected the hands and/or arms. Three fractures were the result of a sports injury. Four of six children with hypermobile EDS, the most common type of the disease, had a history of bone fractures.

The study also included 60 children with generalized joint hypermobility. Fifteen had a history of fracture. Of 19 fractures, 16 happened in the limbs, hands, or feet. All but three children were 5 or older at the time of their fracture, and the earliest occurred at about 1.5 years old.

All the fractures occurred in children who could already walk and were more frequent in EDS or hypermobility than in children from the Ontario population in general (34.6% or 25.4% vs. 7.6%). However, “there were no skull fractures” and “no fractures were reported to have an unidentifiable injury event.”

While the sample size was small and most data were self-reported, the “study supports that EDS or hypermobility should not be used as a medical justification for unexplained fractures in infants,” the researchers said.