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Updated: Jun 28, 2026
10:08
Pseudofracture: An Acute Peripheral Tissue Trauma Model
Published on: April 18, 2011
Does bruising help determine which fractures are caused by abuse?
Thomas J Valvano1, Helen J Binns, Emalee G Flaherty
1Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53201, USA. tvalvano@chw.org
Child Maltreatment
|November 13, 2008
Summary
Bruising near fractures does not reliably indicate child abuse. This study found no significant difference in bruising between abusive and non-abusive fractures, suggesting it
Area of Science:
- Pediatrics
- Forensic Medicine
- Child Health
Background:
- Distinguishing between abusive and non-abusive fractures in children is critical for timely intervention.
- Bruising is often considered a potential indicator of physical trauma, but its association with fractures requires further investigation.
Purpose of the Study:
- To evaluate the utility of associated bruising in differentiating abusive from non-abusive fractures in pediatric patients.
- To determine the sensitivity of bruising near a fracture as a predictor of child abuse.
Main Methods:
- A retrospective study analyzed 150 pediatric patients with acute fractures referred to a child abuse team.
- Fracture causes were independently assessed by two experts, excluding bruising data.
- Associated bruising was defined as occurring at the same body site as the fracture.
Main Results:
- Of 150 patients, 93 (62%) fractures were deemed abusive and 57 (38%) non-abusive.
- Associated bruising was present in 26% of abusive fractures and 25% of non-abusive fractures.
- The overall sensitivity of associated bruising for predicting abuse was low at 26%.
Conclusions:
- The presence or absence of bruising associated with a fracture is not a reliable differentiator between abusive and non-abusive injuries.
- Clinical assessment should not solely rely on bruising to diagnose abusive head trauma or fractures.
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