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Melissa L. Peters, MD; Suzanne P. Starling, MD; Myra L. Barnes-Eley, BS, MPH; Kurt W. Heisler, MS, MPH

Arch Pediatr Adolesc Med. 2008;162(9):877-881.

Objective  To determine the occurrence of bruising near the site of fracture in a group of children with inflicted fractures.

Design  Case series.

Setting  Two children's hospitals.

Participants  Suspected child abuse victims with fractures.

Main Outcome Measure  The presence of bruising and fracture in a single body region or appendage.

Results  The study included 192 children with inflicted fractures. No bruising was found in 111 (57.8%) of the study participants. Forty patients (20.8%) had bruising near the site of at least 1 fracture. Of these, bruising or subgaleal hematoma near the site of a skull fracture was seen most often, in 43.3% of patients. Bruising in association with extremity fractures was seen much less commonly, ranging from 3.8% (n = 2) of children with tibia fracture to 16.7% (n = 1) of children with fibula fracture. Rib fractures also were associated uncommonly with bruising. When skull fractures are excluded, 45 (8.1%) of 555 fractures had bruising near the fracture site, in 13 (6.8%) patients.

Conclusions  In children with inflicted skeletal trauma, the fractured bones that most frequently have associated bruising are the skull bones. The presence of bruising near the fracture site is uncommon in extremity or rib fractures.

Author Affiliations: Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, and The Children's Hospital of Alabama, Birmingham (Dr Peters); and Department of Pediatrics, Eastern Virginia Medical School and The Children's Hospital of The King's Daughters, Norfolk, Va (Dr Starling, Ms Barnes-Eley, and Mr Heisler).

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