1 / 21

Radiology of Child Abuse

Radiology of Child Abuse. Kristy Rollins, M-IV July 25, 2006 Radiology Clerkship. Age at injury. 85% less than 3 years old 69% less than 1 year old Median age = 7 months. Number of Fractures. 50% with single fracture 21% with 2 fractures 12% with 3 fractures

wynter-barton
Download Presentation

Radiology of Child Abuse

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Radiology of Child Abuse Kristy Rollins, M-IV July 25, 2006 Radiology Clerkship

  2. Age at injury • 85% less than 3 years old • 69% less than 1 year old • Median age = 7 months

  3. Number of Fractures • 50% with single fracture • 21% with 2 fractures • 12% with 3 fractures • 17% with more than 3 fractures

  4. Most Common Location • Femur (35%) • Humerus (29%) • Skull (16%)

  5. Most Common Long Bone Fracture • Transverse fracture (48%) • Spiral fracture (26%) • Avulsion fracture (16%) • Oblique fracture (10%)

  6. Increased suspicion if . . . • Inconsistencies/discrepancies in story and injury • Unwitnessed injuries • Injuries blamed on siblings • Injuries inconsistent with patient’s developmental age • Injury inconsistent with mechanism given • On exam if areas in multiple areas of healing are noted.

  7. Workup of suspected abuse • Evaluation for: • Characteristic skin lesions • Swelling/deformity • Bone tenderness • Reluctance to use an extremity • Retinal hemorrhages • Trauma to the genitals • Signs of neglect

  8. Musculoskeletal Exam • Entire skin surface examined • Skeleton showed be examined for deformity • Check range of motion in all joints • Detailed neurological examination

  9. Radiographic Evaluation • Plain films of all areas of questioned present and previous injury • Skeletal survey • Consider radionucleotide scan as alternate to skeletal survey • Ultrasonography: useful for costochondral injuries • DEXA scan: can be used to differentiate OI and abuse

  10. Specific for Intentional Injury • Metaphyseal corner fractures • Posterior rib fractures • Fractures of sternum, scapula, or spinous processes • Multiple fractures in various stages of healing • Bilateral acute long bone fractures • Complex skull fractures

  11. Less Specific for Intentional Injury • Isolated long bone fractures • Simple skull fractures • Clavicle fractures

  12. Fracture healing & dating • Soft tissue changes • Usually apparent for several days • Due to inflammation • Periosteal bone formation • Detectable once calcified • Usually between days 7-14 after injury • Fracture gap widens • Necrotic bone resorbed • Peaks 2-3 weeks after injury

  13. Fracture Healing & Dating (2) • Soft callus • From production/calcification of osteoid • Appears as an increase in density • Hard callus • Lamellar bone bridges the fracture site • 1 week after soft callus • Usually completed healing at 3-6 weeks

  14. Metaphyseal corner fracture http://rad.usuhs.mil/rad/home/peds/frank4arrow.jpg

  15. Metaphyseal corner fracture (2) http://rad.usuhs.mil/rad/home/peds/specmet.jpg

  16. Metaphyseal Corner Fracture (3) http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Pediatrics/Corner%20Fx%20characteristic%20of%20abuse.jpg

  17. Posterior rib fractures http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Pediatrics/Arrowed%20rib%20fractures.jpg

  18. Posterior Rib fracture (2) http://rad.usuhs.mil/rad/home/peds/ribfxoldarrow.jpg

  19. Complex Skull Fracture http://rad.usuhs.mil/rad/home/peds/eggshellarrow.html

  20. Multiple fractures http://rad.usuhs.mil/rad/home/peds/bonescan.jpg

  21. The End

More Related