4. Assessment and Interpretation of Bone Trauma in Children

  1. John Gall2 and
  2. Jason Payne-James3
  1. A. Smith1 and
  2. T. Cain2

Published Online: 14 MAR 2011

DOI: 10.1002/9780470973158.ch4

Current Practice in Forensic Medicine

Current Practice in Forensic Medicine

How to Cite

Smith, A. and Cain, T. (2011) Assessment and Interpretation of Bone Trauma in Children, in Current Practice in Forensic Medicine (eds J. Gall and J. Payne-James), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470973158.ch4

Editor Information

  1. 2

    Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia

  2. 3

    London Hospital Medical College, UK

Author Information

  1. 1

    Royal Australasian College of Physicians (RACP), Australia

  2. 2

    Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia

Publication History

  1. Published Online: 14 MAR 2011
  2. Published Print: 4 FEB 2011

ISBN Information

Print ISBN: 9780470744871

Online ISBN: 9780470973158

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Keywords:

  • bone trauma in children - assessment and interpretation;
  • bone trauma in children, difficulty in detection - in clinical and radiological examination fi ndings, and problematic in analysis;
  • findings, and errors in interpretation - incorrect forensic conclusions, erroneous action on the part of the state, in protecting vulnerable children;
  • essence of forensic evaluation of bone trauma in children - whether bone trauma has occurred, and determining likely mechanism of injury;
  • principles of assessment - forensic evaluation of injury, following a standard pathway;
  • discordance, between history and examination findings - diagnosis of inflicted injury;
  • blood tests, in bone metabolism evaluation - routine procedure, non-accidental bone trauma suspected in children;
  • bone trauma identification, accurately - diagnostic medical imaging techniques, plain X-ray images common, change in appearance of bone after injury;
  • nuclear medicine studies, and gamma ray detection - from radio-pharmaceutical, nuclear medicine bone scans with methylene diphosphonate; 99mTc MDP used;
  • bone injury, nature, extent, cause and possible time - risk to the child, when diagnosis of child abuse is missed or erroneous

Summary

This chapter contains sections titled:

  • Introduction

  • How should I evaluate suspected bone trauma in children?

  • What radiological investigations identify bone trauma?

  • How do X-rays detect fractures?

  • How does ultrasound detect bone injury?

  • How do nuclear medicine scans detect bone injury?

  • How does MRI detect bone injury?

  • How are medical images presented and shared?

  • What forces cause bones to fracture?

  • Are some bone injuries diagnostic of child abuse?

  • What do we know about bone healing in children?

  • What tests detect fragile bones?

  • Neonates with fractures: what are the special considerations?

  • Can the time of bone injury be determined?

  • Why might an X-ray be reported as normal when bone trauma exists?

  • Why might an ultrasound appear normal when bone trauma exists?

  • Why might a nuclear medicine scan appear normal when bone trauma exists?

  • Why might an X-ray appear abnormal when no bone trauma exists?

  • Why might a nuclear medicine scan appear abnormal when no bone trauma exists?

  • How do I deal with correctly interpreted but discordant imaging fi ndings?

  • A. Why might an X-ray appear normal and bone scan ‘hot’ when bone trauma exists?

  • B. Why might a fracture seem obvious on plain X-ray but bone scan is

  • ‘cold’ when bone trauma exists?

  • When and why should I repeat X-rays?

  • How does the process of forming a forensic medical opinion differ from the process of diagnosis in clinical medicine?

  • Why do I need to be aware of my level of confidence in my medical diagnosis?

  • What factors should I consider when forming a diagnostic opinion about the cause of a child's fracture?

  • References