HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kocher, M. S. Articles by Kasser, J. R. Search for Related Content PubMed PubMed Citation Articles by Kocher, M. S. Articles by Kasser, J. R.

Orthopaedic Aspects of Child Abuse

Dr. Kocher is Pediatric Orthopaedic Surgery Fellow, Children’s Hospital, Boston. Dr. Kasser is John E. Hall Professor of Orthopaedic Surgery, Harvard Medical School, and Orthopaedic Surgeonin-Chief, Children’s Hospital, Boston.

Reprint requests: Dr. Kocher, Department of Orthopaedic Surgery, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115.

Increased awareness of child abuse has led to better understanding of this complex problem. However, the annual incidence of abuse is estimated at 15 to 42 cases per 1,000 children and appears to be increasing. More than 1 million children each year are the victims of substantiated abuse or neglect, and more than 1,200 children die each year as a result of abuse. The diagnosis of child abuse is seldom easy to make and requires a careful consideration of sociobehavioral factors and clinical findings. Because manifestations of physical abuse involve the entire child, a thorough history and a complete examination are essential. Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children will eventually be seen by an orthopaedic surgeon. Thus, it is essential that the orthopaedist have an understanding of the manifestations of physical abuse, to increase the likelihood of recognition and appropriate management. There is no pathognomonic fracture pattern in abuse. Rather, the age of the child, the overall injury pattern, the stated mechanism of injury, and pertinent psychosocial factors must all be considered in each case. Musculoskeletal injury patterns suggestive of nonaccidental injury include certain metaphyseal lesions in young children, multiple fractures in various stages of healing, posterior rib fractures, and long-bone fractures in children less than 2 years old. Skeletal surveys and bone scintigraphy with follow-up radiography may be of benefit in cases of suspected abuse of younger children. The differential diagnosis of abuse includes other conditions that may cause fractures, such as true accidental injury, osteogenesis imperfecta, and metabolic bone disease. Management should be multidisciplinary, with the key being recognition, because abused children have a substantial risk of repeated abuse and death.

This article has been cited by other articles:

				R. M. Schwend Abusive Orthopedic Injuries AAP Grand Rounds, November 1, 2007; 18(5): 56 - 56. [Full Text] [PDF]

				D. Brown and E. Fisher Femur Fractures in Infants and Young Children Am J Public Health, April 1, 2004; 94(4): 558 - 560. [Abstract] [Full Text] [PDF]

				N. Trocme, H. MacMillan, B. Fallon, and R. D. Marco Nature and severity of physical harm caused by child abuse and neglect: results from the Canadian Incidence Study Can. Med. Assoc. J., October 28, 2003; 169(9): 911 - 915. [Abstract] [Full Text]

				A. M. Levine Matters of Importance J. Am. Acad. Ortho. Surg., January 1, 2002; 10(1): 5 - 5. [Full Text] [PDF]

				I Trogan, N Dessypris, M Moustaki, and E Petridou How common is abuse in Greece? Studying cases with femoral fractures Arch. Dis. Child., October 1, 2001; 85(4): 289 - 292. [Abstract] [Full Text] [PDF]