The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.
Review last updated in January 2012 
Fractures have been recorded in as many as 55% of young children who have been physically abused 1-3, 18% of whom have multiple fractures 3. Recent literature has explored the value of radiology (skeletal survey) in older toddlers, as well as the benefit of additional imaging. Fractures in physical child abuse denote severe assault and it is essential that they are identified if present. Radiological dating of fractures in children may have a bearing on child protection decision making and new studies have been published relating to this. Changing guidelines with regard to cardiopulmonary resuscitation (CPR) in infants may have a bearing on the risk of rib fractures and recent studies have addressed this.
The review seeks to answer the following review questions:
- What is the evidence for radiological dating of fractures in children?
- What radiological investigations should be performed to identify fractures in suspected child abuse?
- Does cardiopulmonary resuscitation cause rib fractures in children?
References
- Kogutt MS, Swischuk LE, Fagan CJ. Patterns of injury and significance of uncommon fractures in the battered child syndrome. American Journal of Roentgenology, Radium Therapy and Nuclear Medicine. 1974;121(1):143-149 [Pubmed citation only]
- Loder RT, Bookout C. Fracture patterns in battered children. Journal of Orthopaedic Trauma. 1991;5(4):428-433 [Pubmed]
- Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? American Journal of Roentgenology. 2011;197(1):W159-W163 [Pubmed]