The Journal of Bone and Joint Surgery, Vol 77, Issue 8 1179-1183, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Soft-tissue injury as an indication of child abuse
P McMahon, W Grossman, M Gaffney and C Stanitski
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania, USA.
We reviewed the hospital records of 371 children who were suspected of
having been physically abused. Our purpose was to determine specific
features that might be used to distinguish injuries resulting from abuse
from accidental injuries. Soft-tissue injuries were found in 341 (92 per
cent) of these children. Ecchymoses were most common, accounting for 555
(62 per cent) of 892 soft-tissue injuries, and very few had a suspicious
pattern. Only thirty-four (9 per cent) of the children had a
radiographically documented fracture, but radiography was performed for
only thirty-seven (10 per cent) of the patients and it rarely was done
unless a fracture was clinically obvious. The patterns of injury were
age-specific. The forty-four children who were nine months old or less had
an average of only one soft-tissue injury; thirty soft-tissue injuries
involved the head or face, and seven (16 per cent) of the children had a
burn. These children were the most severely injured: two (5 per cent) died
and twenty (45 per cent) had a fracture. The sixty-one children who were
ten months to two years and eleven months old had an average of two
soft-tissue injuries; fifty-four soft-tissue injuries involved the head or
face, and nine (15 per cent) of the children had a burn. A fracture was
found in eight (13 per cent) of these children.(ABSTRACT TRUNCATED AT 250
WORDS)
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