Abstract
Child abuse was the fourth leading cause of death among children 1–4 years of age in 2016 (Heron 2018), and fractures are the second most common type of physical injury due to child abuse (Flaherty et al. 2014). It is imperative that all healthcare professionals possess a good understanding of fractures that are more likely to be abusive in nature. In order to do so, one must have a solid knowledge of the basics of bone structure and health. This chapter provides a fundamental foundation for bone physiology and fracture pathology. It will discuss various fractures and their specificity for abuse. It will explore the mechanical forces necessary to create different types of fractures, equipping the reader with knowledge required to analyze history plausibility as it relates to the fracture in question. This chapter also examines syndromes, metabolic disorders, and diseases that can affect bone health and lead to fractures that could be mistaken for non-accidental trauma. It is also important to evaluate theories of fracture causation that healthcare providers may encounter in the literature or from other healthcare providers. This chapter will explore the medical evaluation needed when a child presents with an injury suspicious for abuse, including the requisite history, physical exam, laboratory studies, and radiologic imaging. Finally, this chapter will guide the healthcare provider through the child abuse evaluation, including the importance of having a pediatric radiologist involved, follow-up skeletal surveys, and the necessity of communication between the general pediatrician, the child abuse pediatrician, and the pediatric radiologist.
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Wade, E., Messner, S., Richer, E. (2022). Fractures. In: Geffner, R., White, J.W., Hamberger, L.K., Rosenbaum, A., Vaughan-Eden, V., Vieth, V.I. (eds) Handbook of Interpersonal Violence and Abuse Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-89999-2_248
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