child abuse Flashcards by Elisabeth Silver

what are low specificity fx’s?

fracture that can happen in abuse and accident

femur fx’s
fibia/fibula fx’s
radius/ulna fx’s
skull fx’s

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what kind of fractures are more commonly abuse in pre-ambulatory children (<1 y/o)?

extremity fractures

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how many fractures are seen in >50% of abusive fx’s?

multiple fx’s

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what are the 4 stages of dating fx’s?

induction, soft callus, hard callus remodeling

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what is the induction phase of dating fx’s? (time characteristics)

3-7 days

inflammation, pain, swelling

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what is the soft callus phase of dating fx’s? (time and characteristics)

infants: 7-10 days
child: 10-14 days

periosteal new bone formation

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what is the hard callus phase of dating fx’s? (time and characteristics)

14-21 days

union at fracture site

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what is the remodeling phase of dating fx’s? (time and characteristics)

3 months -1 year

woven to lamellar bone

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what imaging is recommended for all children <2 y/o if suspect abuse?

skeletal surveys

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most of the fx’s seen on skeletal surgery won’t be evident when?

clinical evident

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skeletal surveys look for evidence of ___ fx’s

prior fx’s

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when do you follow-up with skeletal survey?

at 2 weeks to pick up injury that wasn’t seen before

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what fx’s are highly specific for abuse?

classic metaphyseal lesions (CML)

rib fx’s

acromion

spinous processes

scapular fx’s, sternal and pelvic fx’s, hand and foot in infants, occipital compression fx

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classic metaphysical lesion fx’s are aka?

bucket handle dx b/c get fx at growth plate

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what are bucket handle fx’s caused by?

forceful yanking or shaking

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bucket handle fx’s are found on what imaging?

skeletal survery

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where are bucket handle fx’s the most common?

distal femur, proximal tibia, and distal tibia (b/c near joints)

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what 2 fractures are seen with shaken baby syndrome?

bucket handle fx’s and rib fractures

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what fx’s are pathognomonic for shaken baby syndrome?

posterior rib fractures

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posterior rib fx’s are due to what forces?

compressive

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what 4 boney lesions are mistaken for abuse?

(1) osteogenesis imperfecta
(2) congenital syphilis
(3) osteomyelitis
(4) toddler’s fx

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what does OI look like on x-ray?

radiolucent bones b/c not dense

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s/s of OI? dx?

blue sclera, hearing loss, dental abnoramlities

dx: punch bx

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how does congenital syphilis present?

diffuse osteomyelitis with symmetric metaphysical irregularities and diaphysial fx’s associated with extensive periostitis resembling traumatic lesions

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how do you dx congenital syphilis?

focal erosion on medial aspect of proximal tibia (Wimberger sign) confirmed by serologic testing

presentation of osteomyelitis in kids?

fever, swelling hard to differentiate from abuse -> need good hx and referral to ortho for bx

what is a toddler's fx?

spiral or oblique, non-displaced fx of the mid or distal tibia

does a toddler's fx require a lot of force?

no, so may not be concerned for abuse if good story

age of toddler's fx?

2-4 y/o

what is the definition of abuse?

child < 18 y/o, non-accidental harm (physical, emotional, sexual) adult that is in charge Ota king care of the child is "the abuser"

what is the definition of physical injury?

any injury, death, FTT, addiction to drugs at birth

what is the definition of neglect?

when caretaker deliberately doesn't take care of kid with the resources they have

what is the definition of abandonment?

if leave child with someone or without any building and after 4 weeks they don't attempt to retrieve the child

what does it mean when DCF screens "in"?

follow-up with investigation

what does it mean when DCF screens "out"?

no investigation

if you don't cruise, you don't ___

bruise

what are pre-cruisers?

no upright ambulation

what are cruisers?

walk upright holding onto another person's hand or furniture

what are walkers?

can take >/= 2 independent steps

what are the 4 uncommon areas of accidental bruises?

back, chest, forearm, face

where is bruising on ear common? due to what?

pinna d/t pinching or hand slap to side of head

brushing on neck is most common d/t what?

choking

frenulum tears d/t?

forceful jamming of object into mouth

human bite marks associated with what sign on skin?

petechiae in center of a circular lesion

what is key for bite marks?

photo's

what are 7 injuries often mistaken for abuse?

(1) impetigo (2) coining (3) cupping (4) monogolian spots (5) henoch-schonlein purpura (6) phytophotodermis (7) sunburn

what's the leading cause of death and disability in kids < 2y/o?

abusive head trauma

most accidental closed head injury occurs from what?

significant falls

what are the most common accidental and abusive injuries in young children?

skull fx's

what is the pattern of most abusive skull fx's?

linear

when do you look for abusive head trauma in kids?

presence of multiple fx's, presence of rib fx's, presence of facial injury, < 6 months y/o

what is commonly seen with abusive head trauma?

retinal hemorrhages

what are the retinal hemorrhages d/t?

pulling of vitreous on retina during child being shaken

what MUST you check with head trauma in baby?

the eyes -> for retinal hemorrhages

retinal hemorrhages are evidence towards what syndrome?

shaken baby syndrome

what's the most common type of burns in kids?

scald burns

what is the pattern of accidental scald burns?

see splash marks and are asymmetric

what is the pattern of abusive scald burns?

symmetrical, bilateral, w/out splash marks

what is the doughnut sign? worrisome for what burn?

- spared flexor creases on foot | - worrisome of forced immersion burn

what do immersion burns affect on the body? what do they spare? what does it look like?

affect feet, butt, both legs spares knees sharply delivered with no splash marks, jack-knife posture

what are the most worrisome causes of vaginal discharge concerning for sexual abuse?

Intravaginal foreign body, gonorrhea, trichomonas, syphillis,

what is the MOST concerning cause of veginal discharge concerning for sexual abuse?

gonorrhea

what are the high-risk stirs for abuse?

gonorrhea, chalmydia >3 y/o, HIV with no known RF's

what's the best position for genital inspection in girls?

supine, frog-leg

what position is good for looking at the posterior rim of hymen?

prone, knees to chest

what is the most common area with sexual abuse injuries?

posterior forcet

when should you immediately examine a child for sexual abuse?

bleeding, discharge, injury

what are follow-up resources for sexual abuse?

SANE -if sexual assault occurred w/in last 72 hours or 13 y/o and in last 5 days -trained in forensic medical exams