- Etiology: trauma – shaken or shaken and slammed
- Imaging: specificity of fracture for abuse
— High – classic metaphyseal lesions (bucket-handle fracture on AP view / corner fracture on lateral view), rib fractures (especially posteromedial), scapular fractures, spinous process fractures, sternal fractures
— Moderate – multiple fractures (especially bilateral), fractures of different ages, epiphyseal separations, vertebral body fractures and subluxations, digital fractures, complex skull fractures
— Low – subperiosteal new bone formation, clavicular fractures, long-bone shaft fractures, linear skull fractures - Note: skeletal survey should be repeated at 2 weeks, rib fractures are easy to miss acutely, classic metaphyseal lesions are often bilateral and symmetrical and often heal without callus and may be inconspicuous initially
- DDX:
— Normal variants – skull vascular groove, wormian bone, accessory suture can mimic skull fracture
— Accidents – < 3 yo with femur fracture without good history suspect abuse
— Birth trauma
— CPR – can cause anterior rib fracture
— Copper deficiency
— Menke’s disease
— Skeletal dysplasia – metaphyseal chondrodysplasia type Schmid, spondylometaphyseal dysplasia corner fracture type
— Osteogenesis imperfecta
— Scurvy
— Rickets
— Osteomyelitis – causing periostitis
— Caffey’s disease
— Congenital syphilis
— Leukemia – causing periostitis
— Medications (prostaglandin) – causing periostitis - DDX of classic metaphyseal lesion
— Metaphyseal step-off
— Metaphyseal beak
— Proximal tibia cortical irregularity
— Metaphyseal spur
— Distal femoral + proximal tibial metaphyseal fragmentation with physiologic bowing in > 15 month old - Clinical: incidence is 1 million abused / neglected children in United States / year resulting in 1,500 – 3,000 deaths / year, suspect in children with multiple instances of unexplained trauma, recent unreported physical trauma, history of mild trauma non consistent with severity of injury
Radiology Cases of Child Abuse Musculoskeletal Injury
Radiology Cases of Rib Fractures in Child Abuse







Radiology Cases of Classic Metaphyseal Lesions in Child Abuse


Radiology Cases of Metaphyseal Spur – A Mimic of Classic Metaphyseal Lesions in Child Abuse

Gross Pathology Cases of Child Abuse Musculoskeletal Injury
