Skeletal trauma in child abuse

Abstract

Fractures are common injuries in physical abuse. Though skeletal survey is an important tool for the diagnosis of fractures, it is often performed in an inappropriate way. In this report, we show an example of the protocol of skeletal survey. Most fractures reported in abuse occur in young children, especially <12 months of age. So skeletal survey should be performed in children younger than 2 years with suspected abuse, and follow-up survey is important for children <12 month of age, because the acute fractures of infants are difficult to diagnosis. Follow-up survey can reveal the fractures in the healing phase.

Some fractures are specific for physical abuse, for example, classic metaphyseal lesions (CMLs) and rib fractures in infants. But the rib fractures are often missed, and so we should consider using chest CT in strongly suspected abuse. Finally, it is important to put the patient in a safe environment, and to obtain the most appropriate examinations for precise diagnosis.