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Non accidental injuries

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  • 1. NON ACCIDENTAL INJURIES
  • 2. INTRODUCTION  Commonly known as “ BATTEREDCHILD SYNDROME .“  CAFFEY – introduced the term “whiplash shaken infant syndrome.”  Spectrum of injuries associated with child abuse varying from bruises to burns.
  • 3. RISK FACTORS  Child : o Younger age (< 3yrs) o Low socio economic status o 1 st born o Step child o Unplanned / premature births o Multiple births o Special needs – eg: handicapped  Abuser : o Younger age
  • 4. o Single o Drugs o Parents with h/o abuse o Unemployed
  • 5. History & physical examination  Critical in the diagnosis of non accidental injuries.  When NAI is suspected thorough history  regarding mechanism & duration of injury.  o/e –  soft tissue injuries : most common  bruises, welts, abrasions, lacerations, scars, cigarette burns, bite marks.
  • 6.  Fractures : suspicious fracture patterns  metaphyseal corner #, lower extremity # in non ambulatory children, b/l acute #, rib & spine #, physeal # in young children. Metaphyseal bucket handle or corner # - pathognomonic in abusive trauma. Skull # are difficult to diagnose. Complex skull & rib # in children younger than 2 yrs. posterior rib # -- front-to-back chest compression… Rib # can occur anywhere along the arc.
  • 7. Acute anterior costo chondral seperations can occur, difficult to diagnose with x-rays  usg. Severe lung contusions, necklace calcifications… Spinal # : rare, occcurs whe a child is forcibly slammed on to a flat surface – hyperflexion injury.
  • 8.  Neurological injuries : leading cause of death.  Burns : usually in accidental burns – arrow head configuration, splash marks. Abuse – well demarcated 2nd or 3rd degree burns with circumferential definition.  Abdominal injuries : blunt trauma  Genital injuries
  • 9. Additional imaging studies  Skeletal surveys : in all cases of suspected abuse in children <2 yrs. Includes AP & lateral views of skull, spine; AP of chest, shoulders, pelvis, extremities, feet and hands. Oblique x-rays of hand… Baby-gram not adequate.  Technetium bone scans  Sonograms
  • 10. Interpreting images in child abuse X- ray # patterns in abuse  not characteristic. Spiral # of humerus; tibia, femur…mid shaft or distal fractures. Multiple #, exuberant callus.. Juxtacortical calcification without fractures. The key is to maintain a high level of suspicion
  • 11. Specificity for skeletal trauma in abuse High specificity Any metaphyseal lesion Posterior rib # Scapular # Spinous process # Sternal # Moderate specifity Multiple # espcially b/l # of different ages Epiphyseal seperation Vertebral body # or subluxation Digital # Complex skull # Low specificity Clavicular # Long bone shaft # Linear skull #
  • 12. DATING FRACTURES X-RAY APPEARANCE PEAK CHANGES Resolution of soft tissue swelling New periosteal bone Loss of definition of # line Presence of soft callus Presence of hard callus Remodelling of # 4 – 10 days 10 -14 days 14 – 21 days 14 – 21 days 21 – 42 days 1 year (early – 3 months to 2yrs for maturity )
  • 13. LAB INVESTIGATIONS  CBC, ESR, LFT, URINALYSIS  CLOTTING STUDIES  TOXICOLOGY SCREEN  EVALUATION FOR NON ORTHOPAEDIC INJURIES
  • 14. Thank you

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