Battered Child Syndrome, Bone Injuries (Child Abuse) (Trauma X)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
Not applicable

Pathology:
Not applicable

Imaging Findings:
The imaging study of choice is the plain film skeletal survey.

Multiple fractures, unsuspected fractures, fractures of different ages, a combination of skeletal and non-skeletal injuries, and fractures inconsistent with the clinical history are highly suggestive of abuse.

A diaphyseal fracture is 4 times more common than an epiphyseal-metaphyseal fracture. Skull and rib fractures are also common. Posterior rib fractures are specific evidence of non accidental injury because incidental falls and minor trauma cannot cause them.

DDX:

• Osteogenesis Imperfecta
• Congenital syphilis
• Multifocal osteomyelitis
• Congenital insensitivity to pain
• Menke's syndrome
• Metabolic bone disease (Rickets, renal osteodystrophy, scurvy)
• Metaphyseal dysostosis
• Infantile cortical hyperostosis (Caffey's ds)

References:
See References Chapter.

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