A Practical Guide to Differentiating Abusive From Accidental Fractures: An Injury Plausibility Approach

A young child presents to you for care and you have identified a fracture. Now what? What are the steps you need to take to make sure you are not missing abuse, and what are the most common characteristics of an abuse case? What are common pitfalls that result in an incorrect conclusion? This article will offer a practical approach to the assessment and management of the young child or infant diagnosed as having a fracture. This article will focus on the questions to ask that help ascertain the manner of injury and determine whether the history provided is a plausible explanation of the fracture. A general overview of the literature regarding fractures in children is also provided.