Skeletal Injuries

Although skeletal injuries rarely pose a threat to the life of the abused child, they are the strongest radiological indicators of abuse. In infants less than 1 year of age, certain radiological abnormalities are sufficiently characteristic to allow a firm diagnosis of inflicted injury in the absence of other clinical information. Therefore, imaging surveys performed to identify skeletal injury must be carried out with the same level of technical excellence utilized in examinations routinely performed to evaluate accidental injuries.

In general, the radiographic (x-ray) skeletal survey is the method of choice for skeletal imaging in cases of suspected abuse. A skeletal survey is critical in all cases of suspected physical abuse in children less than 2 years of age. In children older than 5 years, a skeletal survey is of little value in screening for injuries. In children between the ages of 2 and 5 years, the specific clinical indicators of abuse determine whether a skeletal survey should be performed. Skeletal scintigraphy (bone scan) is an excellent adjunct to radiographic skeletal surveys, but extreme caution is indicated in using scintigraphy as a primary screening tool in infants. Whatever the child's age, when the clinical findings point to a specific site of injury, the customary protocol for imaging that region should be followed. Application of these guidelines to cases of neglect and sexual abuse is appropriate when physical maltreatment is also suspected.