Other Fractures of Child Abuse

High specificity for child abuse

• Classic metaphyseal lesions, posterior rib fractures

• Scapular fractures

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    Transverse or oblique fractures of mid acromion process most common

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    Acromion tip fracture mimics ossification center

• Sternal fractures

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    Linear lucency or buckling of anterior cortex

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    Widened sternal synchondrosis or malalignment of sternal segments

• Spinous process fractures

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    Cartilage/bone avulsion at interspinous ligamentous attachment due to hyperflexion & shaking

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    Ossific density adjacent to spinous process may represent acute or remote injury

Moderate specificity for child abuse

• Vertebral body fractures

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    Compression deformity &/or anterosuperior endplate fracture

• Vertebral fracture-dislocations

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    Neurocentral synchondrosis fracture extending through endplate apophyses with retropulsion of vertebral centrum

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    Facet dislocation ± fracture

• Transphyseal fracture/distal humeral epiphyseal separation

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    Capitellar ossification center, radius, & ulna displaced posteriorly & medially relative to distal humerus

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    Distal humeral cartilage maintains alignment with radius & ulna (not true dislocation)

• Complex skull fractures, hand & foot fractures, pelvic fractures

Low specificity for child abuse

• Clavicle, long bone shaft, & linear skull fractures common but have low specificity for nonaccidental trauma

Nonaccidental trauma (NAT)