Commonly known as “ BATTEREDCHILD
CAFFEY – introduced the term “whiplash
shaken infant syndrome.”
Spectrum of injuries associated with child
abuse varying from bruises to burns.
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
o Younger age
o Parents with h/o abuse
History & physical
Critical in the diagnosis of non accidental
When NAI is suspected thorough history
regarding mechanism & duration of injury.
soft tissue injuries : most common bruises,
welts, abrasions, lacerations, scars, cigarette
burns, bite marks.
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.
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.
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
Abdominal injuries : blunt trauma
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
Interpreting images in child
X- ray # patterns in abuse not characteristic.
Spiral # of humerus; tibia, femur…mid shaft or
Multiple #, exuberant callus..
Juxtacortical calcification without fractures.
The key is to maintain a high level of suspicion
Specificity for skeletal trauma
Any metaphyseal lesion
Posterior rib #
Spinous process #
Multiple # espcially b/l
# of different ages
Vertebral body # or subluxation
Complex skull #
Long bone shaft #
Linear skull #
Resolution of soft tissue
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 )
CBC, ESR, LFT, URINALYSIS
EVALUATION FOR NON ORTHOPAEDIC