Certain types of fracture in a child are more likely to indicate physical abuse than others.
Bone Fracture |
High Risk |
Intermediate |
Low Risk |
clavicle |
|
|
low |
digital |
|
intermediate |
|
long bone, epiphyseal separation |
|
intermediate |
|
long bone, metaphyseal ("bucket handle") |
high |
|
|
long bone, shaft (diaphysis) |
|
|
low |
rib |
high (especially if posterior) |
|
|
scapula |
high |
|
|
skull, complex |
|
intermediate |
|
skull, simple |
|
|
low |
sternum |
high |
|
|
vertebra, body |
|
intermediate |
|
vertebra, spinous process |
high |
|
|
Other findings suggesting intermediate risk:
(1) multiple fractures, especially if bilateral
(2) fractures with differing ages
These findings are not pathognomonic, and even high risk fractures may occur in the absence of abuse.
Specialty: Clinical Laboratory, Emergency Medicine, Pedatrics