Fractures of abuse

Question 1

of all non-accidental fractures, what is the most common age group?

Answer 1

80% are less than 18 mo old

Question 2

of non-accidental fractures, who is usually at fault?

Answer 2

80% of cases are parents fault

Question 3

Risk factors for child abuse

Answer 3

Low socioeconomic status, Unplanned pregnancy, Twins, Pre-term children, Special needs children

Question 4

most common injury in child abuse

Answer 4

skin lesions- burns, bruises, lacerations, bites

Question 5

Fractures that are highly specific for abuse

Answer 5

1. posterior rib fx.
2. metaphysical corner fx.
3. Complex skull fx.
4. Long bone fx before walking
5. b/l fx
6. fx in various stages of healing
7. scapular fx
8. outer end clavicle fx
9. vertebral fx/subluxation
10. digital fx in non-mobile

Question 6

most common long bone fxs in abuse

Answer 6

humerus> tibia > femur

Question 7

the most pathognomonic fracture of abuse in children

Answer 7

a transverse fracture- direct trauma to bone- being struck by object

Question 8

metaphysial corner fractures

Answer 8

bucket handle fx. caused by violent shaking, forceful pulling. LE>UE

Question 9

Spiral fractures

Answer 9

are not correlated with abuse

Question 10

indications for skeletal survey

Answer 10

mandatory in any child

Question 11

Skeletal survey components

Answer 11

1. Ap and lateral skull, chest and extremity of interest
2. right and left oblique of chest
3. AP and lateral pelvis, long bones and feet
4. PA oblique of hands and feet

Question 12

Rubin criteria for neuroimaging

Answer 12

if any apply, obtain neuroimaging:
1. 1 fx

4. facial bruising/injury

Question 13

follow up for fx of abuse

Answer 13

repeat XR in 2 weeks for dating of injury