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Pelvic fractures

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.

 

  • Of 540 studies reviewed, nine studies described abusive pelvic fractures 1-9 *
  • Study designs:
    3 cross-sectional 3,5,6
    5 case study / case series 1,2,4,7-9
  • Age range: 2/23 children were aged over ten
  • The majority of children had suffered from multiple additional injuries 1-4,6-9
  • Two studies reported three infants: one child had up to 29 additional fractures recorded 2,9
  • One study reported two case reports: one child had multiple burns and pelvic fractures; one was fatally abused due to associated intra-abdominal injuries 8
  • Five studies included children with pelvic fractures with associated suspected or confirmed sexual abuse definite  1,3-5,8
    • One of these children was disabled and non-verbal 3
  • Fourteen cases of pubic radio-lucency are described. Seven were cases of confirmed abuse, three had fractures of the superior pubic ramus, three had pelvic normal variants and one had indeterminant findings (all seven had multiple associated fractures including metaphyseal) 7
  • A four month old infant with leg pain and swelling had spinal fractures, comminuted fracture of distal left femoral metaphysis and a right ischial tuberosity fracture. These were not evident on the initial plain films but were seen on MRI and on the two week follow-up skeletal survey 2

*The criteria for the ranking of abuse was lowered for the pelvic fractures section. This section relies largely on case studies of rarer fracture types, some of which have a lower abuse ranking

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References

  1. Ablin DS, Greenspan A, Reinhart MA. Pelvic injuries in child abuse. Pediatric Radiology. 1992;22(6):454-457 [Pubmed]
  2. Bixby SD, Wilson CR, Barber I, Kleinman PK. Ischial apophyseal fracture in an abused infant. Pediatric Radiology. 2014;44(9):1175-1178 [Pubmed]

  3. Ellerstein NS, Norris KJ. Value of radiologic skeletal survey in assessment of abused children. Pediatrics 1984;74(6):1075-1078 [Pubmed]
  4. Johnson K, Chapman S, Hall CM. Skeletal injuries associated with sexual abuse. Pediatric Radiology. 2004; 34(8):620-623 [Pubmed]
  5. Lindberg DM, Harper NS, Laskey AL, Berger RP; ExSTRA Investigators. Prevalence of abusive fractures of the hands, feet, spine, or pelvis on skeletal survey: perhaps "uncommon" is more common than suggested. Pediatric Emergency Care. 2013;29(1):26-9 [Pubmed]

  6. Loder RT, Feinberg JR. Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids' inpatient database. Journal of Pediatric Orthopedics. 2007;27(4):421-426 [Pubmed] (Erratum in Journal of Pediatric Orthopedics. 2008;28(6):699)
  7. Perez-Rossello JM, Connolly SA, Newton AW, Thomason M, Jenny C, Sugar NF, Kleinman PK. Pubic ramus radiolucencies in infants: the good, the bad, and the indeterminate. American Journal of Roentgenology. 2008;190(6):1481-1486 [Pubmed]
  8. Prendergast NC, de Roux SJ, Adsay NV. Non-accidental pediatric pelvic fracture: a case report. Pediatric Radiology. 1998;28(5):344-346 [Pubmed]
  9. Starling SP, Heller RM, Jenny C. Pelvic fractures in infants as a sign of physical abuse. Child Abuse and Neglect. 2002;26(5):475-480 [Pubmed]

 

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