What kind of bone fractures are present or indicative of child abuse?

There are types of bone fractures that are highly indicative of child abuse. But any type of fracture may be associated with child abuse injuries. A healthcare provider must always evaluate a child's injury in the context of the child's developmental stage. For instance, non-ambulatory children and infants rarely fracture a bone accidentally. Therefore, it is important to correlate clinical evidence, the type and distribution of associated injuries, the developmental stage of the child with the type of fracture. Because the force required to induce fracture exceeds the force of a simple fall.

Fractures are described according to their anatomical location and characteristic features.

Fractures highly suggestive of child abuse include sternal fractures, scapular fractures, posterior rib fractures, metaphyseal fractures (corner, bucket-handle fractures) and spinous process fractures.

Healthcare providers should automatically consider a child at high-risk for child abuse when parents or caregivers report unwitnessed injuries or report a mechanism of injury that is not consistent with the actual injuries or when the story changes during interviews. Very minor variation in detail from witnesses may or may not be considered suspicious. Therefore, if fractures are present, not withstanding the aforementioned, multiple fractures, fractures of various stages of healing, complex skull fractures and fractures of the vertebral body are moderately suggestive of child abuse.

Child Injury and Child Abuse Cases

What kind of bone fractures are present or indicative of child abuse?

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