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The presence of bruising associated with fractures

Melissa L Peters1, Suzanne P Starling, Myra L Barnes-Eley

  • 1Pediatric Emergency Medicine, The Children's Hospital of Alabama, 1600 6th Ave S, Midtown Bldg, Ste 205, Birmingham, AL 35233, USA. mpeters@peds.uab.edu

Archives of Pediatrics & Adolescent Medicine
|September 3, 2008
PubMed

Insights

Bruising near inflicted fractures is uncommon in children, especially with extremity or rib fractures. Skull fractures are the most frequent exception, often showing associated bruising or subgaleal hematoma.

Area of Science:

  • Pediatric Traumatology
  • Child Abuse Forensics
  • Skeletal Trauma Analysis

Background:

  • Bruising is a common indicator of physical trauma in children.
  • The association between bruising and inflicted fractures requires further investigation to aid in diagnosis.
  • Understanding the patterns of bruising can help differentiate accidental injuries from abuse.

Purpose of the Study:

  • To investigate the occurrence and location of bruising in relation to inflicted fractures in children.
  • To identify which types of fractures are most commonly associated with bruising in cases of child abuse.
  • To provide data that can assist medical professionals in evaluating suspected cases of inflicted skeletal trauma.

Main Methods:

  • A case series study was conducted across two children's hospitals.
  • The study included 192 children diagnosed with inflicted fractures.
  • Data collection focused on the presence of bruising near the fracture site within the same body region or appendage.

Main Results:

  • Bruising was observed in 20.8% of children with inflicted fractures.
  • Bruising was most frequently associated with skull fractures (43.3%).
  • Bruising was uncommon with extremity fractures (3.8% for tibia, 16.7% for fibula) and rib fractures.

Conclusions:

  • In children with inflicted skeletal trauma, skull fractures most commonly present with associated bruising.
  • The absence of bruising does not rule out inflicted injury, particularly in cases of extremity and rib fractures.
  • Bruising patterns near fractures can be a valuable, though not definitive, indicator in the assessment of child abuse.
Abstract

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