Differential Diagnosis Of The Orthopedic Manifestations Of Child Abuse

AuthorSusan A Scherl, MD

Section EditorsWilliam Phillips, MDDaniel M Lindberg, MD

Deputy EditorJames F Wiley, II, MD, MPH

INTRODUCTION

When evaluating the child who is suspected of being physically abused, it is important to remember that findings that appear to be inflicted may result from other causes. The differential diagnosis of child abuse varies depending upon the clinical manifestations. In some cases, the manifestations of abuse are so characteristic that there is no differential diagnosis [1]. Other cases are less clear. In these cases, familiarity with the conditions that can simulate child abuse can facilitate arrival at the correct diagnosis, initiation of appropriate therapy, and avoidance of the consequences of an unnecessary report of suspected child abuse.

The major considerations in the differential diagnosis of a child with potentially inflicted orthopedic trauma include accidental injury, normal variants, birth trauma, metabolic bone disease, skeletal dysplasia (including osteogenesis imperfecta [OI]), infection, drug toxicity, and congenital insensitivity to pain [2-5]. A careful history and physical examination, in conjunction with additional laboratory tests or radiographic studies, if indicated, usually can lead to the proper diagnosis [4,6].

The differential diagnosis of the orthopedic manifestations of child abuse will be discussed here. An overview of the orthopedic manifestations of child abuse and the differential diagnosis of other clinical manifestations of child abuse are presented separately. (See “Orthopedic aspects of child abuse” and “Differential diagnosis of suspected child abuse”.)

ACCIDENTAL TRAUMA

Unintentional injury is a major consideration in all children who present with orthopedic trauma. This is particularly true in children who present with isolated linear parietal skull fractures or diaphyseal long-bone fractures, because these fractures are common in both intentional and unintentional injury [7-10]. (See “Orthopedic aspects of child abuse”, section on ‘Fracture patterns’.)

Even injuries that are highly suggestive of child abuse, such as femoral fractures in infants, may be caused in unusual accidents [11]. Stairway injuries and falls from the arms of caretakers are important sources of accidental skull and long-bone fractures [12-14]. The child’s injuries must be viewed in the context of the child’s age and the purported mechanism of injury [15,16].

Source

http://www.uptodate.com/patients/content/topic.do?topicKey=~MnMuToVKbK5Cgn