Child abuse and its mimics in skin and bone

210 Pages·2013·10.44 MB·English

by  B G Brogdon

K12580_cover 8/15/12 9:46 AM Page 1
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FORENSICS & CRIMINAL JUSTICE B
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Child Abuse
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and Its Mimics in Skin and Bone a
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Of all children reported to child protective services for suspected maltreatment in any form, the
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percentage of substantiated cases of actual physical abuse is quite small. There are a number r
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of dermatological or radiologically demonstrable musculoskeletal lesions that have been, or could
be,mistaken for intentional physical abuse by the inexperienced or untrained observer.
Child Abuse and Its Mimics in Skin and Bone illustrates the classic manifestations of physical C
abuse by dermatological and radiological examination as a standard against which the mimickers h
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of physical abuse can be compared. Beginning with a historical perspective on child abuse, the l
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book explores manifestations of superficial and musculoskeletal trauma in children. It examines
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conditions often mistaken for child abuse, ranging from rubella to leukemia and bowing deformities
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to vitamin A intoxication, as well as a plethora of dermatological conditions that can mimic signs
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of physical abuse.
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Designed for a broad spectrum of individuals who may first encounter a possibly abused child, a
the book presents hundreds of photos—many in color—and examples collected by the authors n
over their years of experience in their respective fields. Where appropriate, the authors provide d

pertinent historical, physical, and laboratory information in support of the diagnosis. I
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With the combined insight of top experts in forensic radiology and dermatology, this volume M
enables clinicians and others confronted with cases involving these conditions to avoid a rush
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to judgment that could wreak havoc in a family and quite possibly delay needed treatment for
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an actual medical condition. c
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Child Abuse
and Its Mimics in
Skin and Bone
TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk
Child Abuse
and Its Mimics in
Skin and Bone
B. G. Brogdon, Tor Shwayder, Jamie Elifritz
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2013 by Taylor & Francis Group, LLC
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Version Date: 20120709
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Dedication
In memory of my precious Babs,
whose boundless love and joie de vivre
enriched my life beyond measure
and inspire me still.
B.G.B.
To the troubled parents, the children who need protection,
and the people who try to help them.
T.S.
To my parents, Barbara and Robert Elifritz,
I wish that every child could experience
the unconditional love, support, and warmth
that was ever abundant in my childhood
and continues to grow during my adult life.
J.E.
TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk
Contents
Preface xi
Acknowledgments xiii
About the Authors xv
1 The Concept of Child Abuse in Historical Perspective 1
Trauma—Inflicted or Accidental? 6
Incidence of Inflicted Trauma 7
Risk Factors 7
Suspicion, Substantiation, or Exclusion of Inflicted Trauma 8
Dermatologic Survey 8
Radiologic Survey 8
References 10
2 Musculoskeletal Trauma in Infants and Children:
Accidental or Inflicted? 13
Part 1: Introduction 13
Injuries to the Bones and Joints in Children: Incidence 13
The Dilemma of Discrimination 13
Context Is Critical 17
Part 2: Radiological Findings in Nonaccidental Trauma 19
Introduction 19
Fractures of the Appendicular Skeleton 20
Metaphyseal Injuries 20
Diaphyseal (Shaft) Fractures 26
Rib Fractures 28
The Scapula 34
The Sternum 34
Hands and Feet 34
Clavicle 35
Multiple Fractures of Different Ages 36
Dislocations of the Appendicular Skeleton 36
Periosteal Reactions 40
Fractures of the Axial Skeleton 42
The Spine 42
The Skull 46
Fractures: Accidental or Abusive? 46
Types of Fractures by Etiology 49
Falls 49
Diagnostic Strategy 49
vii
viii Contents
Facial Fractures 49
Shaken Baby Syndrome 52
References 55
Credits 58
Citations 58
3 Radiological Mimickers of Physical Child Abuse 59
Introduction 59
Metaphyseal Lesions 59
Scurvy 60
Rickets 63
Menkes Disease (Kinky-Hair Syndrome) 68
Congenital Syphilis 68
Intrauterine Infection 73
Rubella (German Measles) 73
Fetal Cytomegalovirus Infection 73
Metaphyseal Chondrodysplasias 75
Schmid Type 75
Leukemia 75
Meningococcemia 77
Little Leaguer’s Shoulder 78
Hypophosphatasia 78
Stippled Epiphyses 80
Fractures and Bowing 83
Perinatal Fractures/Birth Injuries 83
Handling or “Nursing” Fractures 86
Osteogenesis Imperfecta (OI) 87
Temporary Brittle Bone Disease (TBBD) 88
Bowing Deformities 91
Neurofibromatosis 91
Other Causes of Bowing Deformity 92
Congenital Bowing 92
Developmental “Physiologic” Bowing 92
Tibia vara (Blount Disease) 92
Ellis-van Creveld Syndrome (Chondroectodermal Dysplasia) 92
Congenital Indifference to Pain (Hereditary Sensory
and Autonomic Neuropathy) 95
False Fractures 97
Factitious Splitting of the Femoral Head 97
Supernumerary Ossification Centers 98
Panner’s Disease 98
Normal Fractures 100
The “Toddler’s Fracture” 100
Supracondylar Fracture of the Humerus 100
Little Leaguer’s Elbow 102
Dislocations—Nontraumatic, Noninfectious, Nonabusive 102
Contents ix
Arthrogryposis 104
Larsen’s Syndrome 104
Periosteal New Bone Formation 106
Scurvy 106
Rickets 107
Congenital Syphilis 107
Leukemia 107
Osteomyelitis 107
Infantile Cortical Hyperostosis (Caffey Disease) 107
Prostaglandin Therapy 109
Vitamin A Intoxication 110
Familial Hypophosphatemia 111
Normal Physiological Periostitis of the Newborn 111
The Spine 114
Coronal Cleft Vertebra 116
Vertical or Sagittal Cleft 116
Hemivertebrae 118
Spina Bifida 118
Physiological Sclerosis of the Newborn 120
Hurler Syndrome 121
Stippled Epiphyses 123
Infarction 123
Vertebra Plana 123
The Skull 126
Increased Pressure? 126
Fractures 126
Wormian Bones 126
Cephalohematoma 126
Leptomeningeal Cyst 130
Abnormal Fetal Packing 131
Ping-Pong Ball Fractures 132
References 134
Credits 139
4 Dermatological Signs of Physical Abuse 141
Introduction 141
Bruises 141
Abrasions and Lacerations 148
Bite Marks 148
Hair Pulling 149
Burns 150
Burns by Hot Liquids 150
Immersion Burns 150
Splash Burns 152
Contact Burns 152
Neither/Nor Lesions 155