Display options
Cite
Lawson M, Tully J, Ditchfield M, et al. A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury. J Med Imaging Radiat Oncol. 2021;doi: 10.1111/1754-9485.13270.
Lawson, M., Tully, J., Ditchfield, M., Metcalfe, P., Qi, Y., Kuganesan, A., & Badawy, M. K. (2021). A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury. Journal of medical imaging and radiation oncology, . https://doi.org/10.1111/1754-9485.13270
Lawson, Michael, et al. "A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury." Journal of medical imaging and radiation oncology vol. (2021). doi: https://doi.org/10.1111/1754-9485.13270
Lawson M, Tully J, Ditchfield M, Metcalfe P, Qi Y, Kuganesan A, Badawy MK. A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury. J Med Imaging Radiat Oncol. 2021 Jun 26; doi: 10.1111/1754-9485.13270. Epub 2021 Jun 26. PMID: 34176229.
Copy Download .nbib Format: NLM
Share it on

J Med Imaging Radiat Oncol. 2021 Jun 26; doi: 10.1111/1754-9485.13270. Epub 2021 Jun 26.

A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury.

Journal of medical imaging and radiation oncology

Michael Lawson, Joanna Tully, Michael Ditchfield, Peter Metcalfe, Yujin Qi, Ahilan Kuganesan, Mohamed K Badawy

Affiliations

  1. Monash Imaging, Monash Health, Melbourne, Victoria, Australia.
  2. Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
  3. Victorian Forensic Paediatric Medical Service, Monash Children's Hospital, Melbourne, Victoria, Australia.
  4. Department of Medicine, Monash University, Melbourne, Victoria, Australia.
  5. Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.

PMID: 34176229 DOI: 10.1111/1754-9485.13270

Abstract

Non-accidental injuries remain a leading cause of preventable morbidity and mortality in young children. The accurate identification of the full spectrum of injuries in children presenting with suspected abuse is essential to ensure the appropriate protective intervention is taken. The identification of occult bone fractures in this cohort is important as it raises the level of concern about the mechanism of injury and maintaining the child's safety. Radiographic imaging remains the modality of choice for skeletal assessment; however, current studies report concerns regarding the ability of radiographs to detect certain fractures in the acute stage. As such, alternative modalities for the detection of fractures have been proposed. This article reviews the current literature regarding fracture detectability and radiation dose burden of imaging modalities currently used for the assessment of occult bony injury in young children in whom non-accidental injury is suspected.

© 2021 The Royal Australian and New Zealand College of Radiologists.

Keywords: bony fractures; child abuse; imaging; non-accidental injury; review

References

  1. Leaman LA, Hennrikus WL, Bresnahan JJ. Identifying non-accidental fractures in children aged <2 years. J Child Orthop 2016; 10: 335-41. - PubMed
  2. Nimkin K, Kleinman PK. Imaging of child abuse. Radiol Clin North Am 2001; 39: 843-64. - PubMed
  3. Australian Institute of Health and Welfare. Child Protection Australia 2017-18. 2019. - PubMed
  4. Waller AE, Baker SP, Szocka A. Childhood injury deaths: national analysis and geographic variations. Am J Public Health 1989; 79: 310-5. - PubMed
  5. Section on Radiology; American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics 2009; 123: 1430-5. - PubMed
  6. Mettler FA. Medical effects and risks of exposure to ionising radiation. J Radiol Prot 2012; 32: N9. - PubMed
  7. Protection R. ICRP publication 103. Ann ICRP 2007; 37: 2. - PubMed
  8. Kathren RL. Historical development of the linear nonthreshold dose-response model as applied to radiation. Pierce L Rev 2002; 1: 5. - PubMed
  9. Shuryak I, Sachs RK, Brenner DJ. Cancer risks after radiation exposure in middle age. J Natl Cancer Inst 2010; 102: 1628-36. - PubMed
  10. Little MP. Heterogeneity of variation of relative risk by age at exposure in the Japanese atomic bomb survivors. Radiat Environ Biophys 2009; 48: 253-62. - PubMed
  11. ICRP. ICRP Publication 60: 1990 Recommendations of the International Commission on Radiological Protection. Elsevier Health Sciences, Oxford, London, 1991. - PubMed
  12. Offiah A, van Rijn RR, Perez-Rossello JM, Kleinman PK. Skeletal imaging of child abuse (non-accidental injury). Pediatr Radiol 2009; 39: 461-70. - PubMed
  13. Worn MJ, Jones MD. Rib fractures in infancy: establishing the mechanisms of cause from the injuries-a literature review. Med Sci Law 2007; 47: 200-12. - PubMed
  14. Kleinman PK, Perez-Rossello JM, Newton AW, Feldman HA, Kleinman PL. Prevalence of the classic metaphyseal lesion in infants at low versus high risk for abuse. Am J Roentgenol 2011; 197: 1005-8. - PubMed
  15. The Royal College of Radiologists. The Radiological Investigation of Suspected Physical Abuse in Children. The Royal College of Radiologists, London, 2018. - PubMed
  16. Wootton-Gorges SL, Soares BP, Alazraki AL et al. ACR appropriateness criteria® suspected physical abuse-child. J Am Coll Radiol 2017; 14: S338-49. - PubMed
  17. Phillips KL, Bastin ST, Davies-Payne D et al. Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol 2015; 59: 54-65. - PubMed
  18. Halliday KE, Broderick NJ, Somers JM, Hawkes R. Dating fractures in infants. Clin Radiol 2011; 66: 1049-54. - PubMed
  19. Malone CA, Sauer NJ, Fenton TW. A radiographic assessment of pediatric fracture healing and time since injury. J Forensic Sci 2011; 56: 1123-30. - PubMed
  20. Prosser I, Maguire S, Harrison SK, Mann M, Sibert JR, Kemp AM. How old is this fracture? Radiologic dating of fractures in children: a systematic review. Am J Roentgenol 2005; 184: 1282-6. - PubMed
  21. Zimmerman S, Makoroff K, Care M, Thomas A, Shapiro R. Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl 2005; 29: 1075-83. - PubMed
  22. Bennett BL, Chua MS, Care M, Kachelmeyer A, Mahabee-Gittens M. Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes 2011; 4: 354. - PubMed
  23. Harper NS, Eddleman S, Lindberg DM, Investigators E. The utility of follow-up skeletal surveys in child abuse. Pediatrics 2013; 131: e672-8. - PubMed
  24. Harper NS, Lewis T, Eddleman S, Lindberg DM, Investigators E. Follow-up skeletal survey use by child abuse pediatricians. Child Abuse Negl 2016; 51: 336-42. - PubMed
  25. Singh R, Squires J, Fromkin JB, Berger RP. Assessing the use of follow-up skeletal surveys in children with suspected physical abuse. J Trauma Acute Care Surg 2012; 73: 972-6. - PubMed
  26. Harlan SR, Nixon GW, Campbell KA, Hansen K, Prince JS. Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed? Pediatr Radiol 2009; 39: 962-8. - PubMed
  27. Kleinman PK, Nimkin K, Spevak MR et al. Follow-up skeletal surveys in suspected child abuse. AJR Am J Roentgenol 1996; 167: 893-6. - PubMed
  28. Hansen KK, Keeshin BR, Flaherty E et al. Sensitivity of the limited view follow-up skeletal survey. Pediatrics 2014; 134: 242-8. - PubMed
  29. Sonik A, Stein-Wexler R, Rogers KK, Coulter KP, Wootton-Gorges SL. Follow-up skeletal surveys for suspected non-accidental trauma: can a more limited survey be performed without compromising diagnostic information? Child Abuse Negl 2010; 34: 804-6. - PubMed
  30. Gan T, Draus JM Jr. Improving follow-up skeletal survey compliance in suspected nonaccidental trauma patients: what's the FUSS about? Pediatr Qual Saf 2018; 3: e094. - PubMed
  31. Rao R, Browne D, Lunt B, Perry D, Reed P, Kelly P. Radiation doses in diagnostic imaging for suspected physical abuse. Arch Dis Child 2019; 104: 863-8. - PubMed
  32. Berger RP, Panigrahy A, Gottschalk S, Sheetz M. Effective radiation dose in a skeletal survey performed for suspected child abuse. J Pediatr 2016; 171: 310-2. - PubMed
  33. Drubach LA, Sapp MV, Laffin S, Kleinman PK. Fluorine-18 NaF PET imaging of child abuse. Pediatr Radiol 2008; 38: 776-9. - PubMed
  34. Powell-Doherty RD, Raynor NE, Goodenow DA, Jacobs DG, Stallion A. Examining the role of follow-up skeletal surveys in non-accidental trauma. Am J Surg 2017; 213: 606-10. - PubMed
  35. Mettler FA Jr, Guiberteau MJ. Essentials of Nuclear Medicine Imaging: Expert Consult-Online and Print. Elsevier Health Sciences, Philadelphia, PA, 2012. - PubMed
  36. Brenner AI, Koshy J, Morey J, Lin C, DiPoce J. The bone scan. Semin Nucl Med 2012; 42: 11-26. - PubMed
  37. Bainbridge JK, Huey BM, Harrison SK. Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre. Clin Radiol 2015; 70: e83-9. - PubMed
  38. Mandelstam SA, Cook D, Fitzgerald M, Ditchfield MR. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child 2003; 88: 387-90. - PubMed
  39. Prosser IM, Harrison SK. Interpreting fractures in child maltreatment. Paediatr Child Health (Oxford) 2017; 27: 28-32. - PubMed
  40. Adams C, Banks KP. Bone scan. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL, 2019. - PubMed
  41. Sheth S, Colletti PM. Atlas of sodium fluoride PET bone scans: atlas of NaF PET bone scans. Clin Nucl Med 2012; 37: e110-6. - PubMed
  42. Valentin J. Radiation dose to patients from radiopharmaceuticals: (Addendum 2 to ICRP publication 53) ICRP publication 80 approved by the commission in September 1997. Ann ICRP 1998; 28: 1. - PubMed
  43. Stauss J, Hahn K, Mann M, De Palma D. Guidelines for paediatric bone scanning with 99m Tc-labelled radiopharmaceuticals and 18 F-fluoride. Eur J Nucl Med Mol Imaging 2010; 37: 1621-8. - PubMed
  44. Chuang Y-W, Hsu C-C, Chang C-C et al. Multiple bony injuries on bone scan in a case of unsuspected child abuse. Case Rep Med 2017; 2017: 1-4. - PubMed
  45. Treves ST, Baker A, Fahey FH et al. Nuclear medicine in the first year of life. J Nucl Med 2011; 52: 905-25. - PubMed
  46. Drubach LA, Johnston PR, Newton AW, Perez-Rossello JM, Grant FD, Kleinman PK. Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology 2010; 255: 173-81. - PubMed
  47. Sanchez TR, Grasparil AD, Chaudhari R, Coulter KP, Wootton-Gorges SL. Characteristics of rib fractures in child abuse - the role of low-dose chest computed tomography. Pediatr Emerg Care 2018; 34: 81-3. - PubMed
  48. Wootton-Gorges SL, Stein-Wexler R, Walton JW, Rosas AJ, Coulter KP, Rogers KK. Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl 2008; 32: 659-63. - PubMed
  49. Martin A, Paddock M, Johns CS et al. Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT: “a no-brainer?”. Eur Radiol 2020; 30: 1480-7. - PubMed
  50. Bernier M-O, Rehel J-L, Brisse HJ et al. Radiation exposure from CT in early childhood: a French large-scale multicentre study. Br J Radiol 2012; 85: 53-60. - PubMed
  51. Brady Z, Ramanauskas F, Cain TM, Johnston PN. Assessment of paediatric CT dose indicators for the purpose of optimisation. Br J Radiol 2012; 85: 1488-98. - PubMed
  52. Tap NHM, Sidek MAJ, Ridzwan SFM, Selvarajah SE, Zaki FM, Hamid HA. Computed tomography dose in paediatric care: simple dose estimation using dose length product conversion coefficients. Malaysian J Med Sci 2018; 25: 82. - PubMed
  53. Sanchez TR, Lee JS, Coulter KP, Seibert JA, Stein-Wexler R. CT of the chest in suspected child abuse using submillisievert radiation dose. Pediatr Radiol 2015; 45: 1072-6. - PubMed
  54. Esser M, Hess S, Teufel M et al. Radiation dose optimization in pediatric chest CT: major indicators of dose exposure in 1695 CT scans over seven years. Rofo 2018; 190: 1131-40. - PubMed
  55. Huda W. Radiation doses and risks in chest computed tomography examinations. Proc Am Thorac Soc 2007; 4: 316-20. - PubMed
  56. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol 2014; 44: 839-48. - PubMed
  57. Moseley I, Brant-Zawadski M, Mills C. Nuclear magnetic resonance imaging of the orbit. Br J Ophthalmol 1983; 67: 333. - PubMed
  58. Perez-Rossello JM, Connolly SA, Newton AW, Zou KH, Kleinman PK. Whole-body MRI in suspected infant abuse. Am J Roentgenol 2010; 195: 744-50. - PubMed
  59. Johnson KJ, Bache E. Imaging in Pediatric Skeletal Trauma: Techniques and Applications. Springer, New York, NY, 2008. - PubMed
  60. Skellern CY, Wood DO, Murphy A, Crawford M. Non-accidental fractures in infants: risk of further abuse. J Paediatr Child Health 2000; 36: 590-2. - PubMed
  61. Talbot BS, Gange CP Jr, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment. Radiographics 2017; 37: 628-51. - PubMed
  62. Kleinman PK, Marks SC Jr, Nimkin K, Rayder SM, Kessler SC. Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study. Radiology 1996; 200: 807-10. - PubMed
  63. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol 2015; 45: 69-80. - PubMed
  64. Klotzbach H, Delling G, Richter E, Sperhake J, Püschel K. Post-mortem diagnosis and age estimation of infants' fractures. Int J Legal Med 2003; 117: 82-9. - PubMed
  65. Kleinman PK, Marks SC, Adams VI, Blackbourne BD. Factors affecting visualization of posterior rib fractures in abused infants. Am J Roentgenol 1988; 150: 635-8. - PubMed
  66. Dwek JR. The radiographic approach to child abuse. Clin Orthop Relat Res 2011; 469: 776-89. - PubMed
  67. Hansen KK, Prince JS, Nixon GW. Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse-is this practice worthwhile? Child Abuse Negl 2008; 32: 155-9. - PubMed
  68. Ingram JD, Connell J, Hay TC, Strain JD, Mackenzie T. Oblique radiographs of the chest in nonaccidental trauma. Emerg Radiol 2000; 7: 42-6. - PubMed
  69. Marine MB, Corea D, Steenburg SD et al. Is the new ACR-SPR practice guideline for addition of oblique views of the ribs to the skeletal survey for child abuse justified? Am J Roentgenol 2014; 202: 868-71. - PubMed
  70. Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal. Radiology 1983; 146: 377-81. - PubMed
  71. Pickett WJ, Faleski EJ, Chacko A, Jarrett RV. Comparison of radiographic and radionuclide skeletal surveys in battered children. South Med J 1983; 76: 207-12. - PubMed
  72. Sty JR, Starshak RJ. The role of bone scintigraphy in the evaluation of the suspected abused child. Radiology 1983; 146: 369-75. - PubMed
  73. Jaudes PK. Comparison of radiography and radionuclide bone scanning in the detection of child abuse. Pediatrics 1984; 73: 166-8. - PubMed
  74. Conway JJ, Collins M, Tanz RR et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 1993; 23: 321-33. - PubMed
  75. Smith FW, Gilday DL, Ash JM, Green MD. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatr Radiol 1980; 10: 103-6. - PubMed
  76. Frye TR, Shores RM, Slovis TL, Young LW, Helfer RE. Radiological case of the month. Am J Dis Child 1984; 138: 323-4. - PubMed
  77. Cadzow SP, Armstrong KL. Rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes. J Paediatr Child Health 2000; 36: 322-6. - PubMed
  78. Hong TS, Reyes JA, Moineddin R, Chiasson DA, Berdon WE, Babyn PS. Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures. Pediatr Radiol 2011; 41: 736-48. - PubMed
  79. Schulze C, Hoppe H, Schweitzer W, Schwendener N, Grabherr S, Jackowski C. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int 2013; 233: 90-8. - PubMed
  80. Cattaneo C, Marinelli E, Di Giancamillo A et al. Sensitivity of autopsy and radiological examination in detecting bone fractures in an animal model: implications for the assessment of fatal child physical abuse. Forensic Sci Int 2006; 164: 131-7. - PubMed
  81. Spies AJ, Steyn M, Bussy E, Brits D. Forensic imaging: the sensitivities of various imaging modalities in detecting skeletal trauma in simulated cases of child abuse using a pig model. J Forensic Leg Med 2020; 76: 102034. - PubMed
  82. Shelmerdine SC, Langan D, Hutchinson JC et al. Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study. Lancet Child Adolesc Health 2018; 2: 802-11. - PubMed
  83. Kelloff J, Hulett R, Spivey M. Acute rib fracture diagnosis in an infant by US: a matter of child protection. Pediatr Radiol 2009; 39: 70-2. - PubMed
  84. Mulroy MH, Loyd AM, Frush DP, Verla TG, Myers BS, Cameron R. Evaluation of pediatric skull fracture imaging techniques. Forensic Sci Int 2012; 214: 167-72. - PubMed
  85. Howard JL, Barron BJ, Smith GG. Bone scintigraphy in the evaluation of extraskeletal injuries from child abuse. Radiographics 1990; 10: 67-81. - PubMed
  86. Haase GM, Ortiz VN, Sfakianakis GN, Morse TS. The value of radionuclide bone scanning in the early recognition of deliberate child abuse. J Trauma Acute Care Surg 1980; 20: 873-5. - PubMed
  87. Kleinhans E, Kentrup H, Alzen G, Skopnik H, Büll U. Falsch-negatives SkelettSzintigramm bei einer biparietalen Schädelfraktur beim» Battered Child «-Syndrom. Nuklearmedizin 1993; 32: 206-7. - PubMed
  88. Olesen T, Egeblad M, Dige-petersen H, Ahlgren P, Nielsen A-M, Vesterdal J. Somatic manifestations in children suspected of having been maltreated. Acta Paediatr 1988; 77: 154-60. - PubMed
  89. Sharp SR, Patel SM, Brown RE, Landes C. Head imaging in suspected non accidental injury in the paediatric population. In the advent of volumetric CT imaging, has the skull X-ray become redundant? Clin Radiol 2018; 73: 449-53. - PubMed
  90. Kim Y-I, Cheong J-W, Yoon SH. Clinical comparison of the predictive value of the simple skull x-ray and 3 dimensional computed tomography for skull fractures of children. J Korean Neurosurg Soc 2012; 52: 528. - PubMed
  91. Culotta PA, Crowe JE, Tran Q-A et al. Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma. Pediatr Radiol 2017; 47: 74-81. - PubMed
  92. Orman G, Wagner MW, Seeburg D et al. Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging? J Neurosurg Pediatr 2015; 16: 426-31. - PubMed
  93. Prabhu SP, Newton AW, Perez-Rossello JM, Kleinman PK. Three-dimensional skull models as a problem-solving tool in suspected child abuse. Pediatr Radiol 2013; 43: 575-81. - PubMed
  94. Eley KA, McIntyre AG, Watt-Smith SR, Golding SJ. “Black bone” MRI: a partial flip angle technique for radiation reduction in craniofacial imaging. Br J Radiol 2012; 85: 272-8. - PubMed
  95. Dremmen M, Wagner MW, Bosemani T et al. Does the addition of a “black bone” sequence to a fast multisequence trauma MR protocol allow MRI to replace CT after traumatic brain injury in children? Am J Neuroradiol 2017; 38: 2187-92. - PubMed
  96. Kralik SF, Supakul N, Wu IC et al. Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology 2019; 61: 81-7. - PubMed
  97. Young JY, Duhaime A-C, Caruso PA, Rincon SP. Comparison of non-sedated brain MRI and CT for the detection of acute traumatic injury in children 6 years of age or less. Emerg Radiol 2016; 23: 325-31. - PubMed
  98. Ghose S, Rai R, Dowling J, Arumugam S, Schmitt B, Liney G. The potential role of ultrashort echo time sequences in MRI guided radiotherapy. In: MReadings MR RT. Siemens, Munich, 2015. - PubMed
  99. Cho SB, Baek HJ, Ryu KH et al. Clinical feasibility of zero TE skull MRI in patients with head trauma in comparison with CT: a single-center study. Am J Neuroradiol 2019; 40: 109-15. - PubMed
  100. Lindberg DM, Stence NV, Grubenhoff JA et al. Feasibility and accuracy of fast MRI versus CT for traumatic brain injury in young children. Pediatrics 2019; 144: e20190419. - PubMed
  101. Parri N, Crosby BJ, Mills L et al. Point-of-care ultrasound for the diagnosis of skull fractures in children younger than two years of age. J Pediatr 2018; 196: 230-6. - PubMed
  102. Riera A, Chen L. Ultrasound evaluation of skull fractures in children: a feasibility study. Pediatr Emerg Care 2012; 28: 420-5. - PubMed
  103. Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW. Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics 2013; 131: e1757-64. - PubMed
  104. Trenchs V, Curcoy AI, Castillo M et al. Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography? Eur J Emerg Med 2009; 16: 150-2. - PubMed
  105. Parri N, Crosby BJ, Glass C et al. Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study. J Emerg Med 2013; 44: 135-41. - PubMed
  106. Arnholz D, Hymel KP, Hay TC, Jenny C. Bilateral pediatric skull fractures: accident or abuse? J Trauma Acute Care Surg 1998; 45: 172-4. - PubMed
  107. Kleinman PK. Problems in the diagnosis of metaphyseal fractures. Pediatr Radiol 2008; 38: 388. - PubMed
  108. Karmazyn B, Duhn RD, Jennings SG et al. Long bone fracture detection in suspected child abuse: contribution of lateral views. Pediatr Radiol 2012; 42: 463-9. - PubMed
  109. Proisy M, Marchand AJ, Loget P et al. Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. Eur Radiol 2013; 23: 1711-9. - PubMed
  110. Bushberg JT, Boone JM. The Essential Physics of Medical Imaging. Lippincott Williams & Wilkins, Philadelphia, PA, 2011. - PubMed
  111. Darge K, Jaramillo D, Siegel MJ. Whole-body MRI in children: current status and future applications. Eur J Radiol 2008; 68: 289-98. - PubMed
  112. Arthurs OJ, Thayyil S, Addison S et al. Diagnostic accuracy of postmortem MRI for musculoskeletal abnormalities in fetuses and children. Prenat Diagn 2014; 34: 1254-61. - PubMed
  113. Cho K-H, Lee S-M, Lee Y-H, Suh K-J. Ultrasound diagnosis of either an occult or missed fracture of an extremity in pediatric-aged children. Korean J Radiol 2010; 11: 84-94. - PubMed
  114. Marine MB, Hibbard RA, Jennings SG, Karmazyn B. Ultrasound findings in classic metaphyseal lesions: emphasis on the metaphyseal bone collar and zone of provisional calcification. Pediatr Radiol 2019; 49: 913-21. - PubMed
  115. Markowitz RI, Hubbard AM, Harty MP, Bellah RD, Kessler A, Meyer JS. Sonography of the knee in normal and abused infants. Pediatr Radiol 1993; 23: 264-7. - PubMed
  116. O'Connor JF, Cohen J. Diagnostic Imaging of Child Abuse. Williams Wilkins, Baltimore, MD, 1987; 112-8. - PubMed
  117. Carty H, Pierce A. Non-accidental injury: a retrospective analysis of a large cohort. Eur Radiol 2002; 12: 2919-25. - PubMed
  118. Kemp AM, Joshi AH, Mann M et al. What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child 2010; 95: 355-60. - PubMed
  119. Cheung HM, Lau PY. Fractures associated with non-accidental injury-an orthopaedic perspective in a local regional hospital. Hong Kong Med J 2005; 11: 445-51. - PubMed
  120. Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? Am J Roentgenol 2011; 197: W159-63. - PubMed
  121. Blankstein A, Ganel A, Salai M et al. Fracture of the clavicle in the newborn-detection and follow-up by sonography. Aktuelle Traumatol 2001; 31: 27-9. - PubMed
  122. Fadell M, Miller A, Trefan L et al. Radiological features of healing in newborn clavicular fractures. Eur Radiol 2017; 27: 2180-7. - PubMed
  123. Kayser R, Mahlfeld K, Heyde C, Grasshoff H. Ultrasonographic imaging of fractures of the clavicle in newborn infants. J Bone Joint Surg Br 2003; 85: 115-6. - PubMed
  124. Ablin DS, Greenspan A, Reinhart MA. Pelvic injuries in child abuse. Pediatr Radiol 1992; 22: 454-7. - PubMed

Publication Types