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Diagnosis and Treatment of Orthopedic Injury from Child Abuse

Children who are physically abused often suffer orthopedic injuries. Orthopedic surgeons must be able to recognize signs of abuse injuries.
Long-term effects of child abuse include stress, depression, and substance abuse later in life. Violent behavior in teens who were abused as younger children has been documented.

Children who are mistreated are twice as likely to die before the age of 18 compared to those who are not victims of physical abuse. In this article, red flags for possible abuse are described. These include:

  • Vague or conflicting history
  • Reported cause of the injury doesn't match the signs and symptoms
  • Unstable condition with abnormal abdominal exam
  • Child is unconscious or there is a change in mental status
  • Bruising with suspicious patterns (shape of fingers, belt or cord, or
    go all the way around the arm or leg)
  • Bite marks or burns
  • Injuries along the back of the thighs, trunk, neck, or buttocks
  • Many injuries and/or fractures at different stages of healing
  • Broken bones in any child who does not walk yet

    Documentation of suspicious injuries is important. High-resolution photos should be taken of any bite marks, bruising, or other skin marks. A forensic ruler should be used to show the size. Pictures should always be taken before a cast or splint is applied.

    A complete visual exam from head to toe should always be done in any child with suspicious findings. CT scans may be needed to show spinal injury or fractures. The physician must always keep in mind the possibility of osteogenesis imperfecta (OI) as a true cause of bruising and fractures. OI is a disorder of type I collagen that can be difficult to diagnose.

    Treatment of the injuries is fairly straightforward once they have been identified. Recognizing child abuse requires a careful exam and noticing any of the red flags listed. Medical causes of similar findings from OI or other medical conditions such as hemophilia, leukemia, copper deficiency, or birth trauma must be ruled out before concern about possible abuse is reported.

    • Reference: 

    Alan K. Stotts, MD. Orthopaedic Aspects of Child Abuse. In Current Opinion in Orthopaedics. November 2007. Vol. 18. No. 6. Pp. 550-554.

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