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Fractures of the hands and feet in child abuse: imaging and pathologic features
K Nimkin1, M R Spevak, P K Kleinman
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Insights
Fractures of the hands and feet in abused infants are subtle injuries. Imaging and histopathology confirm torus fractures, often indicating forced hyperextension, necessitating detailed skeletal surveys.
Area of Science:
- Pediatric Radiology
- Forensic Pathology
- Child Abuse Detection
Background:
- Child abuse can manifest as fractures, often subtle and overlooked.
- Fractures of the hands and feet are particularly challenging to diagnose in infants.
Purpose of the Study:
- To characterize the imaging and histopathologic features of hand and foot fractures in abused infants.
- To identify key diagnostic indicators for these injuries.
Main Methods:
- Retrospective analysis of imaging findings in 11 abused infants with hand/foot fractures.
- Review of skeletal surveys, nuclear bone scans, postmortem radiographs, and histopathology.
- Correlation of imaging findings with histopathologic confirmation.
Main Results:
- 22 fractures identified: 15 hand (6 metacarpal, 9 proximal phalangeal) and 7 foot (6 metatarsal, 1 proximal phalangeal).
- Torus fractures predominated, consistent with forced hyperextension, confirmed histologically.
- Oblique views and follow-up surveys improved detection; first ray metatarsal fractures were common.
Conclusions:
- Hand and foot fractures are subtle but significant indicators of infant abuse.
- High-detail radiographs of hands and feet are crucial components of skeletal surveys for suspected abuse.
Purpose:
To determine the imaging and histopathologic appearance of fractures of the hands and feet in abused infants.
Materials And Methods:
The imaging findings in 11 abused infants with fractures of the hands and feet were examined retrospectively. All 11 infants underwent skeletal surveys; five infants also underwent nuclear bone scanning. Postmortem radiographs of the specimen and histopathologic data were available in two infants.
Results:
A total of 22 fractures were noted. Six infants had fractures of the hands: six metacarpal and nine proximal phalangeal fractures. Five infants had fractures of the feet: six metatarsal fractures and one proximal phalangeal fracture. Torus fractures predominated, and these patterns were confirmed at the histologic examinations. These morphologic features were consistent with a mechanism of forced hyperextension. Oblique views of the hands and follow-up skeletal surveys aided in detection of these injuries. Four of six metatarsal fractures involved the first ray. Seven patients had three or more additional fractures that involved the long bones of the upper and lower extremities, and seven patients had additional fractures of the ipsilateral extremity.
Conclusion:
Fractures of the hands and feet are subtle but important injuries in abused infants. Well-collimated, high-detail radiographs of the hands and feet should be included in the skeletal survey performed for suspected child abuse.