Vertebral body fractures in child abuse. Radiologic-histopathologic correlates.

RATIONALE AND OBJECTIVES: Vertebral injuries are rarely reported sequelae of child abuse, and little is known concerning the mechanisms of injury and healing. A preliminary investigation of these issues included correlating radiologic and histologic findings in children with vertebral injuries who died of complications relating to physical abuse. METHODS: Ten vertebral body fractures from four abused infants and young children were studied radiologically and histopathologically. RESULTS: Infants ranged in age from 7 to 36 months (mean, 21 months). Three patients died of associated head injuries. One child died after abandonment. There were three pure vertebral body compression fractures, two superior end-plate fractures without compression deformity, and five anterosuperior end-plate fractures with associated compression deformity. Vertebral compression was generally mild (less than 25%). Typically, end-plate injuries were manifest histologically by extension of the fracture through the medullary trabeculae into the proliferative zone of the superior end plate. The resultant pattern was analogous to that described in a previous study, and could potentially result in a growth disturbance at the vertebral end plate. CONCLUSIONS: Observed radiologic patterns and histologic correlates may help explain previously described findings, such as vertebral notching, in abused infants.

Variations in acromial ossification simulating infant abuse in victims of sudden infant death syndrome.

A variation in ossification of the acromial process of the scapula is described. Postmortem radiographs, obtained in 78 infants who died of sudden infant death syndrome, showed an ossific opacity adjacent to the acromial process in 10 infants (13%). This finding was noted bilaterally in six patients and unilaterally in four patients. No two ossicles were identical. Histologically, no growth plate cartilage was evident between the bony structure and the acromion proper; therefore, this appeared to represent a "pseudoepiphysis." Superficially, this normal variation may appear similar to an acromial fracture resulting from infant abuse. However, a careful analysis of the findings of this normal variation should help prevent any confusion with inflicted injury.

Evaluation of soft tissue injury by Tc-99m bone agent scintigraphy.

Six patients with soft tissue injury secondary to different etiologic factors are presented. The degree and extent of tissue necrosis was precisely identified by scintigraphy. In two of these, radionuclide imaging helped to establish accurately the level of amputation that resulted in appropriate wound healing.

Radiologic imaging of inflicted injury in the child abuse syndrome.

Injuries associated with child abuse may involve any anatomic focus and organ system. Although many if not most of the injuries associated with physical abuse cannot serve as definitive evidence of maltreatment, awareness of patterns of injuries in abused infants and children initially may serve to identify potential victims of abuse and stimulate more thorough clinical and radiologic investigation. It is essential that less familiar intracranial and abdominal injuries be thoroughly evaluated for possible abuse when circumstances suggest maltreatment, or no plausible explanation is given for radiologic findings.

Patterns of osseous injuries and psychosocial factors affecting victims of child abuse.

The aim of this paper is to document experience in the management of cases of child abuse with suspected osseous injury, at the Adelaide Children's Hospital, during the period January 1974-December 1986. The study is a retrospective review of the casenotes, radiographs and radiologists' report of 108 consecutive cases with suspected osseous injuries. Information regarding the osseous injuries sustained and the pyschosocial environment surrounding the circumstances of the patients admitted was recorded. Of 108 cases of suspected osseous injuries, 90% had confirmed osseous injury, of whom 56 cases (52%) had multiple fractures. Twenty of the 41 cases of single osseous injury were due to skull fractures. In children less than 12 months of age, long bone injuries were the most common form of presentation, and in 83% of these the injuries were multiple. Metaphyseal injury in association with other fractures was present in 14% of cases, and 8% of cases showed evidence of periosteal reaction to injury. There were two deaths during the period of this study, as a direct consequence of abuse. The main cause of death in both of these cases was the combination of cerebral haemorrhage and liver trauma. There were 10 other deaths not associated with fracture during this period. The analysis of psychosocial factors demonstrated that 48% of the children were first-born and 67% of parents were unemployed. Of the alleged abuser, the mother was known to be responsible in 50% of cases. In 10% of cases, the parent responsible for the injury admitted to the offence at the time of presentation at the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Head injury in child abuse: evaluation with MR imaging.

To evaluate the usefulness of magnetic resonance (MR) imaging in the diagnosis of head injury in child abuse, the authors compared the findings at head MR imaging and computed tomography (CT) in 19 abused children. Subdural hematomas (15 cases), cortical contusions (six cases), and shearing injuries (five cases) were demonstrated to particular advantage with MR imaging. CT remained superior in the detection of subarachnoid hemorrhage. MR imaging appears to be valuable in the assessment of patients with suspected intracranial injury due to child abuse.

Visceral injury in battered children: a changing perspective.

Abdominal or lower thoracic visceral injury was present in 14 of 69 children (20.3%) examined after suspected physical abuse. Of these, 10 were hemodynamically stable and examined with abdominal computed tomography (CT); four were hemodynamically unstable, taken directly to surgery, or died in the emergency room. In the group studied with CT, injuries to solid abdominal organs were most common (hepatic [n = 5], splenic [n = 3], renal [n = 1], adrenal [n = 1], and pancreatic [n = 1]) followed by pulmonary contusion or laceration (n = 2) and pneumoperitoneum due to duodenal transection (n = 1). No additional radiographic abnormalities were noted in five of these children. In the group not studied with CT, injuries to the intestinal tract and mesentery were most common (n = 3), followed by solid organ injury (hepatic [n = 1] and renal [n = 1]) and pulmonary contusion (n = 1). Intestinal, mesenteric, and pancreatic injuries were associated with a poor outcome. CT should be the examination of choice in abused children with suspected intraabdominal injury.