Radiological dating of fractures
Updated content will be indicated on individual review pages.Non-accidental fractures in children are signs of the application of severe external force.At the same time, it is essential that suspicion is not raised inappropriately as the consequences for an innocent but accused parent or guardian are significant.A skeletal survey is performed in cases of suspected abuse to assess and document the extent of previous skeletal injuries.The investigation is not complete without a 10–14 day follow-up chest radiograph.This chapter highlights key features of injuries and injury mechanisms that suggest abuse, the stages of fracture healing are briefly outlined and the chapter ends with a discussion of important differential diagnoses.These stages are visible as such, and can be identified on skeletal radiographs (Fig.The major forms of child abuse are neglect and physical, sexual and emotional abuse.
Radiologists are often the first to suspect NAI when confronted with particular injury patterns, and a knowledge of these is essential if the opportunity to save a child from future neglect is not to be missed.
The systematic review evaluates the scientific literature on fractures published up until February 2017.
It aims to answer the following clinical questions: Fractures are a common manifestation of abuse and are essential to identify if present.
A typical skeletal survey comprises plain films of the following: The ability to date injuries is critical for medicolegal purposes, and thus must be done carefully (please refer to specialist text for specific guidelines). Metaphyseal (and costochondral junction) injuries do not heal with periosteal reaction and if visible are less than 4 weeks old.
Traumatic periosteal injury can be seen up to 7 days post injury (and therefore can be used for dating). Skull fractures also do not heal with periosteal reaction and if seen are less than 2 weeks old.
CONCLUSION: Radiologic dating of fractures is an inexact science.