Citation

Hoytema van Konijnenburg EM, Vrolijk-Bosschaart TF, Bakx R, van Rijn RR. Br. J. Radiol. 2015; 89(1061): 20150822.

Affiliation

3 Department of Radiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

Copyright

(Copyright © 2015, British Institute of Radiology)

DOI

10.1259/bjr.20150822

PMID

26642309

Abstract

OBJECTIVES: Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This paper focuses on femoral fractures in young children. Based on 3 cases, this paper presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. CASES: We describe three cases of young children who are presented to the emergency department because of a suspected femur fracture. Although in all cases the fracture has a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases an accidental mechanism was a plausible conclusion, although in the second case neglect of parental supervision was cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed.

CONCLUSION: Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma-mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information.

Language: en