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Implications for practice

  • Fractures in children less than 18 months of age should be assessed for possible child abuse
  • Multiple fractures are more suspicious of abuse 

Rib Fractures


  • Rib fractures in the absence of major trauma, birth injury or underlying bone disease have a high predictive value for abuse 
  • Multiple rib fractures are more commonly abusive than non-abusive

Femoral Fractures


  • Femoral fractures in children less than 18 months of age are more likely to be due to abuse
  • Significantly more abusive femoral fractures arise in children who are not yet walking
  • Mid-shaft fracture is the commonest fracture in abuse and non-abuse (analysed for all age groups)

Humeral Fractures


  • The majority of accidental humeral fractures in children are supracondylar and the commonest abusive humeral fractures in children aged less than five years are spiral or oblique
  • Humeral fractures in those aged less than 18 months has a stronger association with abuse than those in older children

Skull Fractures


  • Both abusive and non-abusive skull fractures are commoner in younger infants
  • Linear fractures are the commonest abusive and non-abusive skull fracture

Metaphyseal Fractures


  • Metaphyseal fractures are more commonly described in physical child abuse than in non-abuse
  • Classical metaphyseal lesions will only be found if rigorous radiological techniques are applied
  • Metaphyseal fractures have been frequently described in fatal abuse

Other Fractures


  • Vertebral, pelvic, hands, feet and sternal fractures occur in physical abuse: appropriate radiology is required for detection
  • Vertebral fractures may be unstable, early identification is important
  • The presence of tibia/fibula fractures in a child aged less than 18 months is strongly associated with child abuse




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