Fractures Resulting From Inflicted Trauma: Assessing Injury and History Compatibility

Fractures are the second most common presentation of child abuse and may be a marker of an especially volatile and high-risk form of abusive trauma. Abuse is an escalating form of trauma: once a child sustains a fracture, regardless of intentionality, it is highly likely that further harm will occur. Up to 50% of children diagnosed with abusive trauma have healing fractures. The possibility of concomitant injuries of the brain or abdomen must also be considered, even in the absence of symptoms, because of a high incidence of occult injuries in the abused patient. This article will provide an overview of fractures resulting from inflicted trauma in young children and will address the issue of assessing injury and history compatibility. Fact-based cases are provided for illustrative purposes.