UMEM Educational Pearls

Title: Fractures and Child Abuse

Keywords: Child Abuse, Fracture (PubMed Search)

Posted: 3/15/2009 by Michael Bond, MD (Updated: 4/24/2024)
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A lot of what is taught about fracture patterns in abused children has been extrapolated from post-mortem studies which is a different population then what you will see in the Emergency Department. The study referenced did a metanalysis of all the literature in an attempt to determine what fractures suggest abuse and looked at all comers that had fractures. Some of the patterns they were able to extrapolate are:

Fractures from abuse predominately occurred in infants and toddlers
- In children less than 12 one study showed that 80% of all fractures from abuse occurred in children less than 18 months old.
- In children over 5 years old 85% of fractures are not caused by abuse
In children under 3 years old, skull fractures were by far the most common fracture type in both abused and non-abused children.
- However, the presense of a skull fracture only has a 1:3 chance of being from abuse.
- Skull fractures location and type are similar between abuse and non-abuse, though multiple fractures and fractures that cross suture lines are more highly associated with abuse.
There is a strong relationship between multiple fractures and abuse
- 74% of abused children had two or more fractures compared to 16% of non-abused
In the absence of a confirmed traumatic case, rib fractures have the highest probability (71%) of being caused by abuse.
Humeral fractures have a 1:2 chance of being the result of abuse.
Femur fracture like skull fractures have a 1:3 chance of being the result of abuse.

References

Patterns of Skeletal Fractures in Child Abuse: Systemic Review. BMJ, Alison M Kemp et al. 2008;337:a1518