Fractures are the second most common injury in child physical abuse.

High specificity

  • Classic metaphyseal lesions
  • Rib fractures, especially posterior
  • Scapular fractures
  • Spinous process fractures
  • Sternal fractures
  • Any infant with an unexplained fracture

Moderate specificity

  • Multiple fractures, especially bilateral
  • Fractures of different ages
  • Epiphyseal separations
  • Vertebral body fractures and subluxations
  • Digital fractures
  • Complex skull fractures

Common but low specificity

  • Subperiosteal new bone formation
  • Clavicular fractures
  • Long bone shaft fractures, unless child pre-ambulatory
  • Linear skull fractures

Mimics of abuse fractures:

  • osteogenesis imperfecta
  • rickets
  • scurvy
  • syphilis
  • birth trauma
  • neoplasia
  • healed infection

See Radiology reference web page for:

  • stages of bone healing to evaluate for previous injury
  • components of a skeletal survey
  • age-related radiological testing recommendations
  • radiological technique recommendations


[From Kleinman PK ed. Diagnostic imaging of child abuse 2nd ed Mosby 1998 ]