Which skeletal findings should raise suspicion of physical child abuse?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Skeletal injuries in children younger than 2 years may not be obvious; therefore, a skeletal survey screening is recommended (see Workup for the components of the skeletal survey). [22, 23] Many fracture types can be accidental or inflicted. Fractures that raise a high degree of suspicion for inflicted injury include the following:

  • ANY fracture in a nonambulatory infant without clear accidental and consistent mechanism

  • Metaphyseal fractures

  • Multiple, bilateral, differently aged posterior rib fractures (see image below)

  • Multiple and complex skull fractures if only simple impact history

  • Spinous process fractures

  • Scapular fractures

    Radiograph of multiple rib fractures. Radiographs Radiograph of multiple rib fractures. Radiographs also revealed old radius and ulna fracture. The child presented with a slap mark. Image courtesy of Lawrence R. Ricci, MD.

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