Orthopedic aspects of child abuse

Current Opinion in Pediatrics

Volumn 9, Issue 1, 1997, Pages 100-103

  Beaty, James H ^a  

^a UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COLLAGEN;

BONE INJURY; CHILD ABUSE; COLLAGEN SYNTHESIS; DIAGNOSTIC TEST; FRACTURE; OSTEOGENESIS IMPERFECTA; PRIORITY JOURNAL; REVIEW; SOFT TISSUE INJURY;

EID: 0030888972     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-199702000-00020     Document Type: Review

References (17)

1. Males MA: Putting child abuse back on the political agenda. Lancet 1996, 347:488.
2. Wissow LS: Current concepts: child abuse and neglect. N Engl J Med 1995, 332:1425-1431.
3. McMahon P, Grossman W, Gaffney M, Stanitski C: Soft-tissue injury as an indication of child abuse. J Bone Joint Surg Am 1995, 77:1179-1183. Soft tissue injuries were found in 92% of 371 children suspected of having been physically abused and were frequently the only sign of abuse in children 3 years of age or older. Only 9% had radiographically documented fractures.
4. Kleinman PK, Marks SC Jr, Richmond JM, Blackbourne BD: Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR Am J Roentgenol 1995, 165:647-650. Postmortem high-detail skeletal survey, specimen radiography, and histopathologic analysis identified 165 fractures in the 31 infants, of which 84 (51%) involved the ribs and 72 (44%) involved long bones. The metaphysis was more frequently involved (89%) in long bone fractures than was the shaft (11%). Skeletal survey alone identified only 58% of fractures identified histopathologically, and specimen radiography identified 92%.
5. Kleinman PK, Marks SC Jr: A regional approach to the classic metaphyseal lesion in abused infants: the proximal tibia. AJR Am J Roentgenol 1996, 166:421-426.
6. Kleinman PK, Marks SC Jr: A regional approach to the classic metaphyseal lesion in abused infants: the distal tibia. AJR Am J Roentgenol 1996, 166:1207-1212.
7. Kleinman PK, Marks SC Jr: Relationship of subperiosteal bone collar to metaphyseal lesions in abused infants. J Bone Joint Sur Am 1995, 77:1471-1476. Autopsy study of 10 infants with evidence of abuse who died showed that inclusion of the subperiosteal bone collar within the peripheral portion of the metaphyseal fracture fragment explains the radiographic apperance of corner fractures and bucket-handle patterns described by Caffey (AJR Am J Roentgenol 1946, 56:163-173) in abused infants.
8. Blakemore LC, Loder RT, Hensinger RN: Role of intentional abuse in children 1 to 5 years old with isolated femoral shaft fractures. J Pediatr Orthop 1996, 16:585-588. Review of 42 children with isolated femoral shaft fractures found histories suspicious for intentional injury in 14; abuse was documented in only one. The likelihood of intentional injury to the femoral shaft appears to be low in children between the ages of 1 and 5 years.
9. Strait RT, Siegel RM, Shapiro RA: Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse? Pediatrics 1995, 96:667-671. Abuse was diagnosed in nine of 25 (36%) children younger than 15 months of age, but in only one of 99 children older than 15 months of age. Abuse should be considered in children younger than 15 months of age with humeral fracture, including supracondylar fractures, whereas most humeral fractures in older children are accidental.
10. Nimkin K, Kleinman PK, Teeger S, Spevak MR: Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings. Pediatr Radiol 1995, 25:562-565.
11. Strouse PJ, Owings CL: Fractures of the first rib in child abuse. Radiology 1995, 197:763-765.
12. dos Santos LM, Stewart G, Meert K, Rosenberg NM: Soft-tissue swelling with fractures: abuse versus nonintentional. Pediatr Emerg Care 1995, 11:215-216.
13. Lim HK, Smith WL, Sato Y, Choi J: Congenital syphilis mimicking child abuse. Pediatr Radiol 1995, 25:560-561.
14. Steiner RD, Pepin M, Byers PH: Studies of collagen synthesis and structure in the differentiation of child abuse from osteogenesis imperfecta. J Pediatr 1996, 128:542-547. Of 48 children tested, biochemical evidence of OI was present in six (12.5%); in five of these, the diagnosis was already strongly suspected by physicians. Although OI can be diagnosed by biochemical studies in some cases of suspected abuse, clinical evaluation by experienced physicians usually is sufficient to make the diagnosis, and routine biopsy is unwarranted in all children in whom abuse is suspected.
15. Shaw DG, Hall CM, Carty H: Osteogenesis imperfecta: the distinction from child abuse and the recognition of a variant form [letter]. Am J Med Genet 1995, 56:116.
16. Patterson CR, Burns J, McAllion SJ: Osteogenesis imperfecta variant vs. child abuse: reply [letter]. Am J Med Genet 1995, 56:117-118.
17. Smith R: Osteogenesis imperfecta, non-accidental injury, and temporary brittle bone disease. Arch Dis Child 1995, 72:169-176. This thorough review emphasizes the controversy surrounding the differentiation between OI and nonaccidental injury and the use of collagen synthesis for diagnosis of OI. The author gives practical guidelines for determining when collagen synthesis is indicated.