Exam 2 - Pediatric ortho: child abuse

Question 1

Children most at risk of child abuse

Answer 1

• Less than 3 years of age
• First born
• Premature
• Stepchildren
• Developmentally disabled

Question 2

Are fractures or soft tissue injuries seen more often in child abuse cases?

Answer 2

Soft tissue injuries

Question 3

Normal sites of soft tissue injuries vs red flags suggestive of child abuse

Answer 3

Normal: chin, brow, elbows, knees, shins

Red flags: back of head, neck, buttocks, abdomen, legs, arms, cheeks, genitalia

Question 4

Physical exam red flags of child abuse

Answer 4

• Bruising
• Abdominal tenderness
• Bruising or chafing of genitalia
• Decreased LOC

Question 5

If the provider suspects child abuse in a patient that is <2 years old, what imaging/tests should be ordered?

Answer 5

Full skeletal survey

• AP and lateral views of long bones, hands, feet, spine, chest, skull

Question 6

High specificity fractures that can be visualized in older children in x-rays if suspecting child abuse

Answer 6

• Posterior rib fracture
• Scapula fracture
• Posterior process fracture of spine
• Fracture of sternum
• “Corner” or “chip” fracture of metaphysis

Question 7

What causes a “corner” or “chip” fracture of metaphysis?

Answer 7

From downward fraction or pull on the extremity

Question 8

True/false: The provider should suspect child abuse if there are multiple fractures in different stages of healing

Answer 8

True - rule out if patient has osteogensis imperfecta which increases their likelihood of fractures

Question 9

Potential causes of spontaneous fractures (not due to child abuse)

Answer 9

• Neuromuscular disease
• Tumor
• Metabolic disease
• Osteogenesis imperfecta
• Osteomyelitis
• Rickets