You are caring for a 7mo child who is not moving the LUE; a plain film shows a fracture. Child maltreatment is high on your differential. You want to order a skeletal survey and your medical student wants to know precisely what you’re looking for on your survey. You say…
Have the pediatric radiologist review the films (this is the most important thing, since you are not an expert in this particular type of imaging review).
Look for multiple fractures with different stages of healing.
Rib fractures, particularly posterior rib fractures are concerning.
Scrutinize for metaphyseal buckle and chip fractures.
Examine for spiral fractures in long bones; in kiddos who can’t walk this is pretty suspicious.
Note any complex skull fractures.
Check for scapular fractures.
Remember, it is not your job to accuse anyone of child maltreatment; it is not your job to determine if the accompanying adults love the child. The health of the child is your job. If you think this diagnosis is possible, you MUST report. Call the hospital social worker for logistical guidance; NY ACS: 1800.635.1522.
Refs
Mace, SE. Child Physical Abuse: A State-of-The-Art Approach. Pediatric Emergency Medicine Practice. Sept 2004;1(2):1-20.
Zitelli B, Davis H. Atlas of Pediatric Physical Diagnosis. 5th ed.
