Of the following fractures, which is most concerning for non-accidental trauma?
A. 18 month old brought in for refusing to walk, no history of any trauma or fall.
B. 18 month old brought in for refusing to walk, history of falling from a jungle gym approximately 3 feet off the ground.
C. Both are concerning for non-accidental trauma
D. Neither are concerning for non-accidental trauma
Check back in a few days for my answer and others’ comments
Kelly May 4, 2017 - 8:46 am
B. Classic metaphyseal fractures in both the “corner” appearance (femur) and “bucket handle” appearance (tibia and fibula) are present. These types of fractures results from vigorous shaking causing shear forces, and are considered pathognomonic or at least highly concerning for non-accidental trauma. For more information see https://www.hawaii.edu/medicine/pediatrics/pemxray/v4c02.html
A. shows a typical toddler’s fracture. These fractures may present without a known history of falling, usually in a toddler who is not yet walking steadily. For more information see http://www.hawaii.edu/medicine/pediatrics/pemxray/v4c18.html