Home > Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review > Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review

Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review


Nirav K Pandya; Keith Baldwin; Atul F Kamath; Dennis R Wenger; Harish S Hosalkar


Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN.


We therefore (1) determined which bone diseases most commonly mimic CAN; (2) what types of osteogenesis imperfecta (OI) are most commonly confused with CAN and why; and (3) what specific findings in OI and bone disease render a mistaken diagnosis of CAN more likely.


A systematic review of the literature was performed. We identified studies that compared cases of CAN with cases in which patients had bone disease that resulted in an unexplained fracture. We also included studies in which patients with fractures resulting from underlying bony pathology were misclassified as CAN and were subsequently reclassified as bone disease as a result of further investigation. Our search netted only five studies that directly compared and contrasted CAN with metabolic or genetic bone disease in the same study.


The published literature suggests OI is most frequently confused with CAN, although metaphyseal dysplasia, disorders of phosphate metabolism, and temporary brittle bone disease are also documented in the literature identified by our search. Difficulty in differentiating these bony diseases from CAN stems from ambiguity in the history and physical examination at the time of presentation.


Bone disease is a diagnosis of exclusion in the differential diagnosis of CAN.

Title:  Clinical orthopaedics and related research     Volume:  –     ISSN:  1528-1132     ISO Abbreviation:  –     Publication Date:  2010 Sep

Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.



About these ads
  1. No comments yet.
  1. No trackbacks yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


Get every new post delivered to your Inbox.

Join 168 other followers

%d bloggers like this: