Child Abuse

  • Etiology: trauma – shaken or shaken and slammed
  • Imaging: fractures pathognomonic for child abuse – posterior rib fracture (easy to miss acutely) + complex metaphyseal lesion (bucket handle fracture on AP view / corner fracture on lateral view), long bone diaphyseal fractures are most common fracture but non-specific for abuse
  • Clinical: specificity of fracture for abuse
    — High – classic metaphyseal lesion (corner / bucket-handle fracture), rib fracture (especially posteromedia), scapular fracture, spinous process fracture, sternal fracture
    — Moderate – multiple fractures (especially bilateral), fractures of different ages, epiphyseal separation, vertebral body fracture and subluxation, digital fracture, complex skull fracture
    — Low – subperiosteal new bone formation, clavicular fracture, long-bone shaft fracture, linear skull fracture

Cases of Child Abuse