- Discussion:
- child abuse occurs most often under the age of 3 years;
- when child abuse goes unrecognized, the mortality rate may be as high as 5 %;
-
differential dx:
-
osteogenesis imperfecta
- note that w/ some OI phenotypes, radiographic osteopenia may be slight and may be missed on x-ray;
- in these cases, consider
dual energy x-ray absorptiometry;
- references:
- The role of dual energy x-ray absorptiometry in aiding the diagnosis of pediatric osteogenesis imperfecta.
MS Moore. et al.
American Journal of Orthopaedics. Dec 1998. p 797.
- Common Fractures:
- rib fractures: the most commonly found fractures in child abuse (followed by humerus, femur, and tibia);
-
femur fracture: the majority of femur frxs in infants are due to abuse;
The toddler's fracture revisited.
Relationship of the subperiosteal bone collar to metaphyseal lesions in abused infants.
Soft-tissue injury as an indication of child abuse.
Analysis of 429 fractures in 189 battered children.
Orthopaedic aspects of child abuse.
KE Cramer.
Pediatric Clinics of North America. Vol 43(5) 1996. p 1035-1051.
Factors affecting visualization of posterior rib fractures in abused infants.
Kleinman PK, Marks SC, Adams VI, et al: Am J Roentgenol 1988;150:635-638.
The Battered Child Syndrome.
CH Kempe et al.
JAMA. Vol 181. 1962. p 17-24.
Fractures in childhood: osteogenesis imperfecta or child abuse?
DA Dent and CR Paterson.
J Pediatric Orthopedics.
Vol 11(2). 1991. p 184-186.
