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Orthopaedic Manifestations of Child Abuse

- 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%;
    - common patterns for abuse:
           - unwitnessed spiral fractures
           - fractures occuring prior to walking age;
    - 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;

    - skeletal survey: indicated to determine if there are other fractures in different stages of healing; 
    - 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;
                  - reference:
                         - The role of dual energy x-ray absorptiometry in aiding the diagnosis of pediatric osteogenesis imperfecta.

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.   

Factors affecting visualization of posterior rib fractures in abused infants.   

The Battered Child Syndrome.  

Fractures in childhood: osteogenesis imperfecta or child abuse?     

The Radiographic Approach to Child Abuse