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HK J Paediatr (New Series)
Vol 1. No. 2,
1996
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HK J Paediatr (New Series) 1996;1:202-203
Proceedings of Clinical Meeting
Skeletal Complication in Abused Children
ACW Lee, PC Lau, KT So ACW Lee, PC Lau*, KT So Departments of Paediatrics and Diagnostic Radiology*, Tuen Mun Hospital
| HK J Paediatr (new series) 1996;1:193-206 Annual Scientific Meeting
Hong Kong Paediatric Society
December 9, 1995 | Background Skeletal abnormality is both an important clue and a potentially serious complication in the management of abused children. A retrospective study was carried out to examine the prevalence of skeletal complications and the use of diagnostic radiology. Patients and Methods Consecutive cases of suspected child abuse seen at Tuen Mun Hospital from January to December 1994 were reviewed. All children were managed according to the guideline issued by the Social Welfare Department. Result 54 children, including 29 boys and 25 girls, of mean age 7.8 (0.2-17.6) years were recruited. Eight children were discharged when the allegation could not be substantiated on initial investigation. Skeletal survey was performed in 39 children. Abnormalities were found in eight of which 6 were ascribed to the abuse. These included 3 cases of single fracture, 2 cases of multiple fractures, and 1 case of grossly delayed bone age due to untreated hypothyroidism. The results were tabulated as below. | | Skeletal Survey (% in parentheses) | | Age (years) | Abnormal | Normal | Not Done | Total | | 0-3.99 | 3# (23) | 10 (77) | 0 | 13 | | 4-7.99 | 4* (36) | 6 (55) | 1 (9) | 11 | | 8-11.99 | 0 | 10 (83) | 2 (17) | 12 | | 12 or above | 1^ (10) | 5 (50) | 4 (40) | 10 | | | 8 (17) | 31 (67) | 7 (16) | 46 | #2 children had multiple fractures and the other had delayed bone maturation;
*one child was incidentally found to have short metacarpals; the other 3 children had single fractures;
^the child was incidentally found to have multiple skeletal fibromas. | After multi-disciplinary conference, 7 (15%) children were concluded to have either sexual or psychological abuse, or gross neglect. 22 (48%) children were abused physically, with or without other forms of abuse. Skeletal signs were either contributive or conclusive in substantiating the diagnoses. With the exception of children under the age of 4 years, skeletal fractures were hinted by the presence of localized pain and swelling. Conclusion Skeletal survey is an important adjunct in the diagnosis of child abuse in children under 4 years of age. More selective approach in the use of diagnostic radiology is justified in older children according to the symptomatology and background of abuse.
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