Jeffrey Linzer Sr. This article is adapted from one that originally appeared in the July issue of Pediatric Emergency Medicine Reports. According to one study, as many as one in five children seen in the emergency department ED may be missed cases of physical abuse; thus, emergency physicians have a responsibility to consider abuse in the differential of every injured child. Physical abuse is most simply defined as injury inflicted on a child by a caregiver. The identification of child abuse requires the completion of a medical and social evaluation, and should be followed by the notification of child protective services CPS. This sensitive and often difficult situation presents a unique challenge for both the medical staff and the family, and requires thoughtful coordination and cooperation between ED personnel, social workers, CPS, law enforcement personnel, and inpatient hospital staff. The incidence of non-sexual child abuse in the United States is difficult to ascertain, but is believed to be much higher than reported. According to NIS-4 data, more than 1. This corresponds to one child in every 58 in the United States.
Aging After Brain Injury: BrainLine Talks with Dr. Steven Flanagan
Where a skull fracture is identified in a child, there will be concerns about how it has been caused and whether it was a result of non-accidental injury. If a non-accidental injury is suspected within care proceedings, often a medical expert neuroradiologist will be instructed to consider the injury and any explanations for it. I hope the following may explain a little about the skull and skull fractures. As the largest bone, the parietal bone is the most likely bone to fracture in an accident.
Subsequently, suspicion often arises if it is one of the other bones that has fractured.
Seizures to date have not been shown to cause retinal hemorrhage in Finally, dating skull fractures is difficult because they do not heal with the typical.
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The Presence of Bruising Associated With Fractures
All rights reserved. King Tut probably died from a broken leg, scientists say, possibly closing one of history’s most famous cold cases. A CT scan of King Tutankhamun’s mummy has disproved a popular theory that the Egyptian pharaoh was murdered by a blow to the head more than 3, years ago. Instead the most likely explanation for the boy king’s death at 19 is a thigh fracture that became infected and ultimately fatal, according to an international team of scientists.
The team presented its results this week at the annual meeting of the Radiological Society of North America in Chicago, Illinois.
More serious skull fractures will require treatment and maybe surgery. Last review date: July Ref: F
Differences in types of artificial cranial deformation are related to differences in frequencies of cranial and oral health markers in pre-Columbian skulls from Peru. Museu de Arqueologia e Etnologia. Artificial cranial deformation is a cultural practice that modifies the shape of the skull during the early infancy. It is not related to rites of passage, but to different social status in a group. Therefore, the deformed cranium is an expression of individual affirmation and affiliation to a given social group.
Osteological material from Pasamayo AD , a cemetery in central coast of Peru, was analyzed to test whether individuals presenting different types of cranial deformation interpreted as a sign of different social status present differences in health status.
Child bone fracture
Children throughout the world experience physical abuse that may go unnoticed. Radiologists may be the first clinicians to identify signs of potential abuse. The number of articles published in peer-reviewed journals about this subject has increased markedly over the past decade. A recent two-article series in Clinical Radiology provides a concise and informative review of the important factors and signs of inflicted skeletal injury.
The authors list common clinical features that should raise suspicion of an inflicted injury.
Metaphyseal fractures; Skull fractures; Scapular fractures; Head trauma (Dwek, ). Bone healing and dating of injuries. Physical abuse is rarely a onetime.
Bilateral skull fractures in infancy may result from accidental or abusive injury. Consultation with a child abuse pediatrician may assist with determining the likelihood of accident or abuse. Diagnostic considerations for the infant with bilateral skull fractures are reviewed, including single impact, double impact, and compression mechanisms of injury, as well as the possibility of accessory sutures as skull fracture mimics.
Illustrative cases exemplify the evaluative process, including obtaining a detailed history, assessing for the presence or absence of additional physical or radiographic signs of injury, screening for psychosoical risk, and obtaining three-dimensional reconstruction of CT bone images. An understanding of plausible mechanisms of injury that can result in bilateral skull fractures in infancy can assist with making an accurate determination of likelihood of accident or abuse.
Skull fractures in infancy are common in both accidental trauma and inflicted injury. When the mechanism of injury provided on history does not seem to be a plausible explanation of the injurious findings, concern for inflicted injury may lead to child pro-tection agency involvement and an investigation. Although often suspicious for abuse, some studies support that complex skull fractures, including bilateral fractures, can occur accidentally, 8 , 9 even from a single impact event.
This article reviews the diagnostic considerations when evaluating an infant with the finding of bilateral skull fractures.
Infant skull fracture risk for low height falls
Child abuse is a problem of particular concern to physicians and other professionals caring for children. Symptoms of physical abuse in children, especially infants, are often nonspecific and may overlap with numerous other clinical conditions. Therefore, radiologists play a key role in identifying imaging findings to make the diagnosis of physical child abuse.
Although many injury patterns may be seen with both accidental and nonaccidental trauma, there are some characteristic findings and injury patterns of abuse that should be recognized by radiologists who interpret pediatric imaging studies. This review covers the characteristic imaging manifestations of child abuse, as well as diagnostic pearls, pitfalls, and limitations associated with skeletal, intracranial, spinal, and abdominal injuries.
Aside from cutaneous findings, such as bruising and contusions, fractures are the next most common findings in abused children.
The doctors considered this to be a skull fracture caused non-accidentally. ‘It is not possible to accurately date skull fractures on the basis of the radiological.
By Emma Glanfield for MailOnline. Six-year-old Ellie Butler suffered two previous skull fractures before she died including one dating back to when her father was first accused of assaulting her as a baby, a court heard today. The youngster was allegedly battered to death by Ben Butler at their home in Sutton, London, in , just 11 months after he won a legal battle to get her back after she was taken into care.
The Old Bailey trial has heard how stay-at-home father Butler, 36, was convicted of hurting Ellie in when she was six weeks old but was later cleared on appeal. Scroll down for video. Six-year-old Ellie Butler pictured suffered two previous skull fractures before she died including one dating back to when her father Ben Butler was first accused of assaulting her as a baby, the Old Bailey heard today.
On the day of her death, jobless Butler was alone with Ellie and another child while her mother Jennie Gray, 36, was at work as a graphic designer in the City of London. In a call to emergency services, he claimed ‘my little girl has fallen down’ but the prosecution say he inflicted catastrophic head injuries by throwing her against a wall or by hitting her with a heavy object. Bone pathology expert Professor Anthony Freemont, of the University of Manchester, gave evidence for the prosecution today.
He told jurors there were four distinct periods of injuries, including ‘at least two or three instances of significant skull trauma’. A healed skull fracture could have dated back to the first allegation of assault by Butler in , he said. Three to five weeks before her death, Ellie suffered a broken shoulder bone. Little Ellie is alleged to have been beaten to death by her ‘violent’ year-old father Ben Butler pictured together, left, with her mother Jennie Gray in a moment of rage.
Her mother Ms Gray is pictured right.
Childhood injuries are not unusual as children develop skills in walking, climbing and so forth. When doing an assessment, it is important to know what level of activity fits a development stage. A detailed history of the event in which the injury occurred is necessary.
o Assessment of intracranial injuries, skull fractures, solid organ, hollow viscera injury o Adjunct for evaluating axonal shear injuries and dating intracranial.
Caffey described the effects of shaking on infants, and its association with bilateral retinal hemorrhage and the typical metaphyseal corner fracture 7. His theory of whiplash-shaking was supported by the finding of bilateral subdural hemorrhage, and the frequent absence of evidence of impact injury. It is true that while it is unusual to slap or spank an infant, the significance of shaking or jerking has only been realized in recent times. Shaking produces repeated acceleration— deceleration forces, so-called whiplash, mainly in an antero-posterior direction, but the brain will also rotate within the calvarium, as a secondary motion.
These movements can cause tearing of the delicate bridging veins, which course from the cerebral cortex, through the subarachnoid space and the potential subdural space, to drain into the venous sinuses. This results in hemorrhage into the subarachnoid or subdural spaces Fig. The infant brain is more at risk from a shaking injury due to its greater relative weight, the lack of tone in the supporting muscles of the neck, and the poor myelination associated with a higher water content.
The relative degree of myelination contributes to the development of shearing injuries, most commonly at the gray—white interface, with a subcortical or callosal location.
Reprinted with permission of the American College of Radiology. No other representation of this material is authorized without expressed, written permission from the American College of Radiology The babygram , which is a single image of the entire chest and abdomen as well as the extremities, is inadequate. Peripheral areas are incorrectly exposed, and subtle fractures can be missed.
A child bone fracture or a pediatric fracture is a medical condition in which a bone of a child is Multiple fractures of varying age, bilateral fractures, and complex skull fractures are also linked to abuse. Fractures of Broken Bones, kidshealth.org, Reviewed by: Peter G. Gabos, MD Date reviewed: April Retrieved Sep.
Radiologists may be the first clinical staff to suspect non-accidental injuries when confronted with a particular injury pattern. Knowledge of these is essential if the opportunity to save a child from future neglect is not to be missed. At the same time, it is essential that suspicion is not raised inappropriately as the consequences for an innocent but accused parent or guardian are significant.
Over recent years, there have been a number of titles given to the constellation of injuries that are the result of the physical abuse of children. A skeletal survey is performed in cases of suspected abuse to assess and document the extent of skeletal injuries. Lead markers should be used in skeletal surveys and some institutions will repeat radiographs that do not have a lead marker within the primary field.
Bone scans are performed in some institutions because of their ability to detect radiographically-occult fractures. A number of fractures have been recognized as highly specific to non-accidental injuries rather than accidental injury. They include:. It is the most sensitive in detecting fractures of rib, scapula, spine, diaphysis and pelvis. The test becomes positive few hours after injury. Normally there is high uptake in the epiphyses of bones which should not be confused with a fracture 9.
Evaluation of Physical Abuse in Children
Skull fractures can lead to an early death, even if the victims initially survived the injuries, according to a new study that looked at skulls from three Danish cemeteries with funeral plots dating from the 12th to the 17th centuries. This is the first time that researchers have used historical skulls to estimate the risk of early death among men who survived skull fractures , experts said. The study showed that these men were 6.
Complex skull # (brain injury common fatal injury in Dating fractures in infants.
Fractures are common injuries in childhood. While most fractures are caused by accidental trauma, inflicted trauma maltreatment is a serious and potentially unrecognized cause of fractures, particularly in infants and young children. This practice point identifies the clinical features that prompt concern for inflicted skeletal injury and outlines a management approach based on current literature and published guidelines, including the clinician’s duty to report suspicion of child abuse to child welfare authorities.
This document does not address isolated skull fractures. Many inflicted fractures are clinically unsuspected, largely because they occur in the pre-verbal, non-ambulatory age group 4—6. In cases of child maltreatment, the history may also be incomplete, misleading or unknown by the presenting caregiver. No specific fracture type is pathognomonic for inflicted injury 7 , 8. Fracture patterns in both maltreatment and accidental circumstances are often specific to age or development level.
Therefore, understanding the typical spectrum of injuries that children sustain as they mature is important. This practice point addresses the following questions in the context of current published recommendations on child maltreatment:. The process of bone growth and mineralization is most dynamic during childhood. Knowledge of the common mechanisms for any given fracture type, combined with relevant clinical information, can guide the clinician as to the plausibility of reported injury mechanisms Figure 1 9 ,