Nonaccidental trauma
| Nonaccidental trauma |
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Overview
Nonaccidental trauma is the radiology term for child abuse. It is estimated that in 2001, 903,000 children (Comparison: the incidence of osteosarcoma in the US is 400 cases per year.) were victims of maltreatment including:
- Neglect (57%)
- Medical neglect (2%)
- Physical abuse (19%)
- Sexual abuse(10%)
- Psychologic maltreatment (7%)
Cutaneous injury is the most common injury due to abuse.
Skeletal trauma is the second most common manifestation of abuse.
Virtually every type and location of fracture has been documented in abused children. Fracture is documented in 11%–55% of physically abused children.
- In a large series of abuse-related fractures,
- 76%: long bones
- 8%: skull
- 8%: rib cage
- The American College of Radiology (ACR) and the Section on Radiology of the American Academy of Pediatrics recommend that a high-quality radiographic skeletal survey involve the use of a high-resolution imaging system, with technical factors designed to optimize image contrast and spatial resolution include an appropriate number of well-collimated views of each anatomic region.
- Babygram is not acceptable
Metaphyseal Fracture
- Virtually pathognomonic of abuse
- Distal femur, proximal tibia, distal tibia, and proximal humerus
- Discovered in 39%–50% of abused children less than 18 months of age
- Almost exclusively in children less than 2 years of age
- Generated by manual to-and-fro manipulation of the extremities
- holding and shaking an infant by the feet or hands
- shaking the infant while he is held around the chest, with the limbs whiplashing back and forth
Rib fractures
- Strongly correlated with abuse because the mechanism that generates the fractures is relatively specific.
- Fractures of the first rib are considered virtually diagnostic of child abuse, since they require considerable force.
- Very tight hold around the infant chest generates substantial squeezing force on the immature skeleton
- May result in fractures of the anterior, lateral, and posterior aspects of the rib.
Skull fractures
- Skull fractures result from contact injury
- Object striking the skull
- Skull as it strikes a stationary object (as in a fall)
- Studies have demonstrated that multiple fractures, fractures that cross sutures, and bilateral fractures are more likely to be associated with abuse