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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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