Fractures
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 ]