Unintentional fractures in kids are much more common than fractures caused by child abuse, but orthopaedists should remain on the lookout for inflicted injuries. To help clinicians assess whether childhood fractures are the result of abuse, the American Academy of Pediatrics (AAP) recently published some guidance.
According to the AAP, classic metaphyseal lesions and rib, scapular, sternal, and spinous-process fractures have a high specificity for child abuse in infants and toddlers. In addition, childhood fractures occurring in the following contexts should raise the suspicion of abuse:
- The fracture is in a nonambulatory child. (Research suggests that 80% of all child-abuse-caused fractures occur in kids younger than 18 months.)
- The history provided by the caregiver is implausible relative to the injury sustained.
- Multiple fractures, fractures of different ages, or other suspicious injuries are present.
- There was a delay in seeking medical treatment.
The article also provides guidance for conducting medical exams, lab work, imaging, and sibling evaluations to arrive at an accurate diagnosis.