Child Abuse Flashcards
Extremity fractures in per-ambulatory children?
most commonly abusive
In abuse cases the fractures are often
- multiple fractures in multiple locations
- in different stages of healing
Staging of fracture healing and how long it takes
induction: 7-10 days
soft callus: infants 7-10 days and children 10-14 days
hard callus: 14-21 days
remodeling: 3 months to 1 year
When do you do skeletal surverys on children
- all children <2y w/ obvious abusive injuries
- all children <2 with any suspicious injuries
- infants with unexplained sudden death
- infants and young toddlers w/ unexplained intercranial injury
- twins of abused children
- household contacts of an abused child
What fractures are highly specific for abuse
- classic metaphyseal lesion
- rib fracture
- acromion
- spinous processes
- scapular
- sternal and pelvic
- hand and foot fractures in infants
- occipital impression fx
Classic metaphyseal lesion is caused by what
shearing and tensile stress from forceful yanking or shearing
Classic metaphyseal lesion AKA
bucket handle
Most common location for CML fracture
- dital femur
- proximal tibia
- distal tibia
Are rib fractures associated with birth trauma or CPR trauma?
no
In order for a rib to fracture what is required
high energy impact due to compressive forces not direct blows
What do posterior rib fractures involve
-the head of the rib at the costovertebral articulation
or
-the neck near the constotransverse process articulation
What can be mistake for abuse
- osteogenesis imperfecta
- congenital syphillia
- osteomyelitis
Toddlers fracture?
subtle, spiral or oblique non displaced fracture of the mid of distal tibia
*minimal trauma or no hx of trauma
Is a toddlers fracture concerning for abuse
nope!
Broken femur in non ambulatory child?
suspect abuse, takes a lot of force to break it
Things that fall under the category of physical injury
- death
- fracture of bone, subdural, burns, impairment of any organ
- soft tissue swelling or skin bruising
- addiction to drug at birth
- failure to thrive
What are the steps in reporting to DCF
- gather all the information you need
- inform the parent that you are reporting (have a complete H and P first)
- do not discharge family until report has been made
How do you file to DCF
- fill out 51A
- call DCF hotline to make verbal report
*tell the screener if you deem an emergency response necessary
