Child abuse most often occurs under 3 years of age, and if it is not recognized and reported, repeat abuse may occur in 40% of the cases. Death can occur in up to 5% of cases.
Risk factors for Child Abuse include:
- Being the first born child
- Single Parent
- Disabled Child
- Parents were abused
It is important to rule out osteogenesis imperfecta and metabolic bone disease.
Suspect Child abuse if:
- There is a fractured femur in an infant before walking age
- The most common orthopaedic injury associated with child abuse is a femur fracture
- Multiple fractures in different stages of healing
- Callus and periosteal reaction is seen
- Unwitnessed spiral fracture
- Spiral fractures are not a good criteria because most of them are accidental
- Multiple soft tissue bruising
- Skin lesions are the most common
- Bone fracture is the second most common
- Corner fracture
- Metapheseal fracture especially in the distal femur and proximal tibia
- Child abuse should be considered when health care providers see corner fractures in children before they are of walking age.
- Posterior rib fracture from a squeezing injury
- If there is a transepiphyseal separation in the humerus
- In Newborns
- The olecranon moves posteriorly
- Looks like an elbow dislocation
- Older Child
- Separation of the distal humerus usually occurs in younger ages
- In Newborns
Discrepancy in the history is a clue. It is hard to explain the injury and match it with the given mechanism of the injury. Injuries in abuse mostly occur at the humerus, tibia, and femur (more in the diaphysis). When child abuse is suspected in a patient it is important to recognize the symptoms, be non-judgmental, and obtain a skeletal survey. If you suspect abuse and a skeletal survey is negative, obtain a bone scan to verify. Then consult protective services. The most frequent cause of long-term morbidity in an abused child is a head injury.