Probability of Physical Abuse of a Child Based on the Type of Fracture

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.

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