The Presence of Bruising Associated With Fractures

Peters, M.; Starling, Suzanne P.; Barnes-Eley, Myra; Heisler, Kurt W.

doi:10.1001/archpedi.162.9.877

Cited by 51 publications

(28 citation statements)

References 23 publications

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“…The majority of children with fractures do not have bruising associated with the fracture; the presence or absence of such bruising does not help to determine which fractures are caused by child abuse. 103,104 Bruising in a child who is not yet cruising or bruising in unusual locations, such as the ears, neck, or trunk should raise suspicion for child abuse. 105,106 The child should be examined for other injuries caused by child abuse, in addition to signs of other medical conditions associated with bone fragility.…”

Section: Physical Examinationmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

246

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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Section: Physical Examinationmentioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

246

162

View full text Add to dashboard Cite

show abstract

“…Bruising overlying metaphyseal fractures is often absent. 9 The metaphysis is the part of the bone between the diaphysis or shaft of the bone and the growth plate. The metaphyseal fracture seen in NAI is a transmetaphyseal disruption of the trabeculi of the primary spongiosa of the growing bone.…”

Section: Metaphyseal Facturesmentioning

confidence: 99%

“…It has however been noted that bruising is absent in over half of children with inflicted fractures and when present it may be well away from the site of injury. 9 An ophthalmological examination will evaluate possible retinal haemorrhage. Detailed documentation is paramount especially for court proceedings that may follow.…”

mentioning

confidence: 99%

(iv) Imaging of non-accidental injury

Kraft

2011

Orthopaedics and Trauma

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“…They may not be appreciated on clinical examination, because excluding the skull, bruising near the site of skeletal trauma is only seen in 10% of infants and children at the time of presentation 3 4. Conversely, the presence of a bruise does not necessarily indicate an underlying fracture.…”

Section: Fractures and Imaging In Child Abusementioning

confidence: 99%

Imaging in suspected child abuse: necessity or radiation hazard?

Bajaj¹,

Offiah

2015

Arch Dis Child

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Imaging has many uses, but in cases of suspected child abuse, radiographs and CT scans are vital in identifying fractures and head injury that may not be clinically obvious. There are growing concerns about the small but potential adverse effects of radiation, including cancer, in the paediatric population as a result of imaging. The vast majority of general paediatricians undertaking child abuse assessments request skeletal surveys and CT scans, subjecting children to significant amounts of radiation. Informed consent must be taken from parents for these procedures and therefore this paper aims to look at evidence of the dangers of radiation in children and raise awareness among paediatricians.

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The Presence of Bruising Associated With Fractures

Abstract: In children with inflicted skeletal trauma, the fractured bones that most frequently have associated bruising are the skull bones. The presence of bruising near the fracture site is uncommon in extremity or rib fractures.

Cited by 51 publications

References 23 publications

Evaluating Children With Fractures for Child Physical Abuse

Evaluating Children With Fractures for Child Physical Abuse

(iv) Imaging of non-accidental injury

Imaging in suspected child abuse: necessity or radiation hazard?

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