Orthopaedic Aspects of Child Abuse

Abstract

Child abuse is a pervasive social and medical problem that remains a major cause of disability and death among children. Increased awareness has lead to a better understanding of the social, medical, and epidemiologic aspects of this complex issue. During 2005, 899,000 children in the 50 states, the District of Columbia, and Puerto Rico were determined to be the victims of abuse or neglect, and nearly 1,500 children died as a result of this maltreatment. The diagnosis of child abuse is seldom easy to make and involves a careful consideration of sociobehavioral factors and clinical findings. Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children are eventually seen by an orthopaedic surgeon. Thus, an understanding of the differences in the general and musculoskeletal manifestations of accidental and nonaccidental injury is essential for recognition and appropriate management of the abused child. There is no pathognomonic fracture pattern in child abuse. Rather, the age of the child, the overall injury pattern, the stated mechanism of injury, and pertinent psychosocial factors must all be considered in each case. Musculoskeletal injury patterns suggestive of abuse include multiple fractures in various stages of healing, posterior rib fractures, and long bone fractures in children younger than 2 years.

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