Figure 1. Anteroposterior radiograph of the left tibia.
Figure 2. Lateral radiograph of the left tibia.
A 6-month-old infant presents to the emergency department with left leg pain and contusions about the head and torso. Anteroposterior (AP) and lateral radiographs of the left tibia show a displaced left tibial shaft fracture. Child abuse is suspected considering the patient’s injury pattern.
Which of the following would not be a sign of child abuse?
Submit your diagnosis to see full explanation.
Child abuse is an unfortunate reality that is seen frequently in the emergency department.1 Detecting child abuse is critical to ensure the child is removed from an abusive setting and transitioned to a safe environment. In some circumstances, orthopedic providers may be the first to recognize suspected abuse based on patient history and injury pattern. Historical findings that may indicate child abuse include parental delay in presenting injuries, a vague history of injury or fall, and insufficient mechanism of injury explained to support the injury.
Children who may be at increased risk for abuse include those <3 years of age, those presenting with behavioral problems, stepchildren, and children whose parents are of low socioeconomic status. Fracture patterns associated with child abuse include rib fractures, multiple fractures, fractures in various stages of healing, a long bone fracture in a child <2 years of age, vertebral compression fractures, and metaphyseal corner fractures.2 A metaphyseal corner fracture is characterized by a small piece of bone avulsed off the metaphysis of long bones. The injury occurs when a child <2 years of age is shaken by the torso, which causes whiplash or shear forces to long bones of the extremities.
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Guenther E, Knight S, Olson LM, Dean JM, Keenan HT. Prediction of child abuse risk from emergency department use. J Pediatr. 2009;154(2):272-277.
- Kocher MS, Kasser JR. Orthopaedic aspects of child abuse. J Am Acad Orthop Surg. 2000; 8(1):10-20.