What is the pathophysiology of physical child abuse injuries?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Each form of injury sustained by a child as a result of physical abuse has its own set of biomechanics and pathophysiology. This article looks specifically at the mechanisms of injury for skeletal injury, burns, bruising, and CNS injury observed in abusive head trauma.

Skeletal fractures are caused by the application of force to the bone. An essential step in the evaluation of injury in children is determining whether the injury being evaluated matches the history provided by the caregiver. This process requires understanding both the mechanisms and forces needed to cause specific types of fractures as well as specific characteristics of infant and childhood bone compared with adult bone.

The child's immature skeleton is characterized by more porous/trabecular bone than in the mature bone. The less-dense porous bone tolerates more deformity than adult bone and accounts for the childhood bending and buckling injuries observed with green stick and buckle injuries. The periosteum (the fibrous membrane that covers the bone) is thicker and more easily elevated off the bone in children. The child's joint capsule and ligaments are strong and relatively more resistant to stress than the bone and cartilage, which accounts for less joint dislocations and ligamentous tears in childhood. Finally, bone healing is more rapid in children than in adults, which makes dating of childhood fractures more complicated.

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