child abuse Flashcards
physical abuse
deliberate physical force- that leads to a physical unjurt t that child
what are all the forms of abuse
sexual, pyhysical, psychological and neglect
psycological scars
although we cannot see psycological scars, they are still there and are important in regars to abuse
imbalance of power
child will not rat ou partent because they feel they are nothing without them
what three things to do if abuse is suspected?
1) through history 2) physcial examination 3) radiologic examination
what are the general injury characteristics?
1) injuries in various stages of healing
2) multiplanar injuries (dont make anatomical sense)
3) patterned injuries (hands, belt buckles)
4) locations typical of assault
What are the %’s for abuse fractures in childhood vs >1 year olds?
30% childhood and 75% for >1 year olds
rib fractures
usually anterior and posterior. If significant, may damage the underlying organs
humeral and femural
most likly an inflicted injury
What two things are important when looking into injuries in children, more important than fracture direction?
age and location
age 0-1 ___ and age 1-2 ____. The injuries commonly seen in these age groups?
age 0-1 is 1/3, 85-90% head injuries
age 1-2 is 2/3, 50% head, 50% blunt abdominal injuries
what increases the rate of detection of child abuse?
systemic screening- increases 5X
What are the 5 child abuse mimics?
1) congenital indifference to pain
2) congenital insensitivity to pain
3) congenital conditions such as meningomyelocele
4) acquired spinal cord injuries
5) acquired cerebral inuries
skeletal survey?
it is a precise set of defined X-ray views to get a full picture of potential abuse cases
What is subdural haemorrhaging? what causes it?
bleeding of the brain between the internal aspect of the skull between brain. It is often caused by the severing of the bridging viens in the skull
Inconsistency of story and injury?
1) incompatible injuries with age of the child
2) injuries disproportionate to their purposed cause
3) injuries may be inappropriate to the purported mechanism of injury
“wrong age, wrong magnitude, wrong mechanism”
mutiple fractures at mutliple sites and multiple stages of healing?
indicative of repeated injury. Most commonly seen in long bones, skull and ribs
What are the two usual types of single fractures seen in children?
transverse fractures and spiral fractures. “a child with a single acute fracture is quite hard to diagnose”
Most common fracture sites (in decreasing order)
Long bone, skull, ribs
What is just as important as X rays in diagnosing abuse?
X rays are suggestive and diagnosis
exams and history is also important
What can happen during delivery?
accidental distal humerus #
deliberat clavicular #
Salter-Harris epiphyseal type 1 injuries?
a seperation at the ephyseal and metapseal plates during child birth
What are some diseases that may simulate abuse in X-rays?
1) congenital syphillis
2) scurvy
3) hypervitaminosis A
4) caffey’s disease
5) osteogenesis imperfecta
congenital syphyillis?
see new periosteum bone growth and erosions near metaphyses
scurvy and hypervitaminosis A
periosteum is elevated by bleeding underneath
caffeys disease
significant diaphyseal new bone formation in ling bone but not metaphyses
osteogenesis imperfecta
Type I and IV are most resembling of child abuse, fractures occur with minimal trauma
Why do injury patterns seen in infants differ so much from older children
mechanism and different skeletal responses.
Common injuries in < 1 yrs vs > 1 yrs?
< 1yrs= ribs, metaphyseal regions
>1yrs= long bones, skull, ribs
what causes CML bilteral vs unilateral?
hold child by thorax and shaking them- bilateral
hold by one arm or leg and shaking them- unilateral
What side of child is most commonly injured on children? and why>
left side because most people are right handed
what injuries are highly specific for abuse/\? (6)
CML, rib ( esp posterior), scapular, vertebral processes, sternal, and some spiral diaphyseal fractures
Combination of what three things are indictive of abuse?
1) fracture type
2) history
3) developmental stage
shaken baby head injuries? why?
brain injuries (contusion or laceration) and bridging veins causing subdural haemorrahage. They have weaker neck muscles so they have minimal protection against whiplash
Shaken baby bone injuries? (3)
1) metaphyseal fractures
2) epiphyseal seperation
3) subperiosteal new bone formation along shafts of long bone
what % of shaken babies survive? what happens to the surviving %?
80%
1/3- server mental outcomes (seizures)
1/3- dysfunctions (learning disabilities)
1/3- good outcome (27% recover)
CML are highly indictive of abuse in what ages?
under 2
define CML?
subepiphyseal planar series of microfractures through the most immature portion of metaphyseal bone
what allows for firm attatchment of periosteum and metaphysis?
metaphyseal fenestrations. increases biomechanical strength
common sites for CMLs?
knee, ankle, and distal humerus
What is the actual lesion seen in CMLs?
they are complete or partial mineralized disc avulsions
what are the different ways tou can see fracture on X-ray
direction of X-ray projection, size of injured area, and degree of bone periphery involvement
shaft spiral/ oblique fractures?
torsion force and the distal base of the bone and causes a spiral fracture.
comparing shafts fractures with CML fractures?
shaft fractures are more commonly seen than CMLs but are less specific than CMLs
femural and humeral fractures differences?
humeral- diagnostics
femural- suggestive
suspicious for diaphyseal injuries?
dumb story, delayed treatment, no history of injury, other signs (physical, emotional)
what causes the shaft fractires in femurs?
grabbing at knee, calf, and ankle. The strong ligaments protect at knee and hip.
torus type fracture?
cortex buckling caused by microfractures usually near metaphysis.
common rib fracture areas?
near costotransvers articulation and posteriorly due to squeezing laterally.
lateral fractures are also seen from a central force.
what acts as a fulcrum to posterior rib fractures?
lateral tip of transverse process
significant anterior central chest blow?
fracture childs sternum and fracturing of costal cartilages. may also cause seperation of the costochondral junction of costa.
skull bones fractured in decreasing order?
parietal, occiptal, frontal , temporal
most common skull fracture patterns seen in abuse?
depressed, complex, wide, and multiple
what are some stability mechanisms of the brain
bridging viens, brainstem, and 4 infoldings of dura
what two things cause brain/skull injury?
movement and deformation
why does head of inertial properties?
the brain and skull are independent and move independently
shear strain occuring in brain
a chage in shape of brain without change of volume
myelination importance?
less myelination in kids and increase plasticity and result in more sugnificant ofr to injure brain
