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Child Abuse: Extremities
Donna G. Blankenbaker, MD, FACR; Andrew Sonin, MD, FACR; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Nonaccidental trauma
            • Trauma X
            • Battered child syndrome
            • Shaken baby syndrome
          • Definitions

            • Skeletal injury to child due to violent act of another individual
              • Other organ injuries often seen as well

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Cannell JJ et al: Multiple unexplained fractures in infants and child physical abuse. J Steroid Biochem Mol Biol. 175:18-22, 2018
                                        2. Raynor E et al: The detection of significant fractures in suspected infant abuse. J Forensic Leg Med. 60:9-14, 2018
                                        3. Barber I et al: The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol. 45(1):69-80, 2015
                                        4. Deutsch SA: A struggle for certainty--protecting the vulnerable. N Engl J Med. 372(6):506-7, 2015
                                        5. Phillips KL et al: Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol. 59(1):54-65, 2015
                                        6. Flaherty EG et al: Evaluating children with fractures for child physical abuse. Pediatrics. 133(2):e477-89, 2014
                                        7. Shelmerdine SC et al: Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures. Clin Radiol. 69(12):e512-6, 2014
                                        8. Meyer JS et al: ACR Appropriateness Criteria(®) on suspected physical abuse-child. J Am Coll Radiol. 8(2):87-94, 2011
                                        9. Ravichandiran N et al: Delayed identification of pediatric abuse-related fractures. Pediatrics. 125(1):60-6, 2010
                                        10. Hansoti B et al: Limb fractures and nonaccidental injury in children less than 24 months of age. Eur J Emerg Med. 15(2):63-6, 2008
                                        11. Peters ML et al: The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 162(9):877-81, 2008
                                        12. Coffey C et al: The risk of child abuse in infants and toddlers with lower extremity injuries. J Pediatr Surg. 40(1):120-3, 2005
                                        13. Grayev AM et al: Metaphyseal fractures mimicking abuse during treatment for clubfoot. Pediatr Radiol. 31(8):559-63, 2001
                                        14. Nimkin K et al: Fractures of the hands and feet in child abuse: imaging and pathologic features. Radiology. 203(1):233-6, 1997
                                        15. Kleinman PK et al: A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus. AJR Am J Roentgenol. 167(6):1399-403, 1996
                                        16. dos Santos LM et al: Soft tissue swelling with fractures: abuse versus nonintentional. Pediatr Emerg Care. 11(4):215-6, 1995
                                        17. Conway JJ et al: The role of bone scintigraphy in detecting child abuse. Semin Nucl Med. 23(4):321-33, 1993
                                        18. Stewart G et al: Trauma in infants less than three months of age. Pediatr Emerg Care. 9(4):199-201, 1993
                                        19. Oestreich AE et al: The periphysis and its effect on the metaphysis: I. Definition and normal radiographic pattern. Skeletal Radiol. 21(5):283-6, 1992
                                        20. McClelland CQ et al: Fractures in the first year of life. A diagnostic dilemma. Am J Dis Child. 136(1):26-9, 1982
                                        21. Paterson CR: Vitamin D deficiency rickets simulating child abuse. J Pediatr Orthop. 1(4):423-5, 1981
                                        22. Jaffe AC et al: Multiple metatarsal fractures in child abuse. Pediatrics. 60(4 Pt 2):642-3, 1977
                                        23. Wilkinson RH et al: Pediatric skeletal trauma. Curr Probl Diagn Radiol. 6(2):1-37, 1976
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Nonaccidental trauma
                                                  • Trauma X
                                                  • Battered child syndrome
                                                  • Shaken baby syndrome
                                                • Definitions

                                                  • Skeletal injury to child due to violent act of another individual
                                                    • Other organ injuries often seen as well

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Cannell JJ et al: Multiple unexplained fractures in infants and child physical abuse. J Steroid Biochem Mol Biol. 175:18-22, 2018
                                                                              2. Raynor E et al: The detection of significant fractures in suspected infant abuse. J Forensic Leg Med. 60:9-14, 2018
                                                                              3. Barber I et al: The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol. 45(1):69-80, 2015
                                                                              4. Deutsch SA: A struggle for certainty--protecting the vulnerable. N Engl J Med. 372(6):506-7, 2015
                                                                              5. Phillips KL et al: Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol. 59(1):54-65, 2015
                                                                              6. Flaherty EG et al: Evaluating children with fractures for child physical abuse. Pediatrics. 133(2):e477-89, 2014
                                                                              7. Shelmerdine SC et al: Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures. Clin Radiol. 69(12):e512-6, 2014
                                                                              8. Meyer JS et al: ACR Appropriateness Criteria(®) on suspected physical abuse-child. J Am Coll Radiol. 8(2):87-94, 2011
                                                                              9. Ravichandiran N et al: Delayed identification of pediatric abuse-related fractures. Pediatrics. 125(1):60-6, 2010
                                                                              10. Hansoti B et al: Limb fractures and nonaccidental injury in children less than 24 months of age. Eur J Emerg Med. 15(2):63-6, 2008
                                                                              11. Peters ML et al: The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 162(9):877-81, 2008
                                                                              12. Coffey C et al: The risk of child abuse in infants and toddlers with lower extremity injuries. J Pediatr Surg. 40(1):120-3, 2005
                                                                              13. Grayev AM et al: Metaphyseal fractures mimicking abuse during treatment for clubfoot. Pediatr Radiol. 31(8):559-63, 2001
                                                                              14. Nimkin K et al: Fractures of the hands and feet in child abuse: imaging and pathologic features. Radiology. 203(1):233-6, 1997
                                                                              15. Kleinman PK et al: A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus. AJR Am J Roentgenol. 167(6):1399-403, 1996
                                                                              16. dos Santos LM et al: Soft tissue swelling with fractures: abuse versus nonintentional. Pediatr Emerg Care. 11(4):215-6, 1995
                                                                              17. Conway JJ et al: The role of bone scintigraphy in detecting child abuse. Semin Nucl Med. 23(4):321-33, 1993
                                                                              18. Stewart G et al: Trauma in infants less than three months of age. Pediatr Emerg Care. 9(4):199-201, 1993
                                                                              19. Oestreich AE et al: The periphysis and its effect on the metaphysis: I. Definition and normal radiographic pattern. Skeletal Radiol. 21(5):283-6, 1992
                                                                              20. McClelland CQ et al: Fractures in the first year of life. A diagnostic dilemma. Am J Dis Child. 136(1):26-9, 1982
                                                                              21. Paterson CR: Vitamin D deficiency rickets simulating child abuse. J Pediatr Orthop. 1(4):423-5, 1981
                                                                              22. Jaffe AC et al: Multiple metatarsal fractures in child abuse. Pediatrics. 60(4 Pt 2):642-3, 1977
                                                                              23. Wilkinson RH et al: Pediatric skeletal trauma. Curr Probl Diagn Radiol. 6(2):1-37, 1976