Pediatric Radiology > Musculoskeletal > Trauma > Non-Accidental Trauma

Non-Accidental Trauma

Child abuse, or non-accidental trauma, is an all-too-common entity. Estimates have suggested that over one million children (most under one year of age) are seriously injured and up to 5000 children killed each year in the United States secondary to physical abuse. When suspicions of potential abuse are raised due to either clinical or radiographic findings, a skeletal survey must be obtained.

A skeletal survey consists of :

  • two views of the skull

  • lateral thoracic and lumbar spine

  • AP views of both upper and both lower extremities

  • AP views of both hands and both feet

  • AP view of the Pelvis

  • may require CT scan of head

  • may require repeat skeletal survey in two weeks to look for healing injuries not seen on initial survey


Specific Radiographic findings suggestive of abuse:

  • posterior rib fractures near costovertebral joints: highly specific for abuse; likely mechanism involves excessive squeezing force applied to infant's thorax

  • metaphyseal corner fractures: likely secondary to forceful pulling of an extremity

  • spiral fractures of long bones in non-ambulatory infants

  • multiple fractures in different areas of the body and at different ages of healing

Skeletal survey performed on a 10-month-old male demonstrates multiple findings of abuse. AP chest radiograph (left) reveals multiple broken ribs as evidenced by the callus formation seen on both the lateral and posteromedial aspects of the right ribs #2-6 and on the lateral aspect of the left rib #5. Radiograph of left knee (center) reveals corner fractures (arrows) of the medial and lateral aspects of the distal femoral metaphyses. Note the periosteal reaction on the medial aspect of the tibial shaft. Axial CT image (right) shows subdural hemorrhages in the frontal and occipital lobes and along the falx.

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