This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (2)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Child Abuse  • Surgery  • Violence and Human Rights  • Diagnosis  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Child Abuse Fatalities: Pattern of Injury
Greeley
AAP Grand Rounds 2009;22:31-31.
FULL TEXT  

Femur fracture in an infant
Radesky and Sugar
BMJ 2009;338:b1583-b1583.
FULL TEXT  

Limited Association of Bruises with Fractures in Child Abuse Victims
Paul
AAP Grand Rounds 2009;21:13-13.
FULL TEXT