ORTHOPEDIC ASPECTS CHILD ABUSE. A summary of the physical, metaphysical, psychological, and sociological aspects of Non-

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1 ORTHOPEDIC ASPECTS OF CHILD ABUSE A summary of the physical, metaphysical, psychological, and sociological aspects of Non- Accidental Injury with specific references to both the perpetrator and victim Definition Public Law (1996) at a minimum, any act or failure to act resulting in the imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of a child by a parent, or caretaker who is responsible for the child s welfare. 1

2 Child Abuse Sexual Abuse Emotional Abuse Neglect Physical Abuse Definition Acts of commission or omission which directly or indirectly cause harm to a child 2

3 Differential Diagnosis Osteogenesis Imperfecta Metabolic Bone Disease Accidental Trauma Real Case Day 2 18 mo. old child unwitnessed fall Swollen foot, large bruise Neg. x rays Babies died. They starved, they were beaten, they died of the flu. They fell out of windows, they died of SIDS. They were snatched out of cars, they were lured away from playgrounds, they were abused by priests. And there were fates worse than that. She knew of those, too. 3

4 How some adults were actually excited by the cries of small children. How even a baby, a weak helpless baby, should fall into the wrong hands and through no fault of its own, become a predator s toy Alone by Lisa Gardner Demographics 2/3 Medicaid as Primary payer 1/2 < 1 year old 41% of deaths < 1 year old 76 % of deaths < 4 years old About ½ ages 3 20 yr. old victims have psychiatric or neurologic condition Stepmother Indicted in Death of Disabled NC Girl The Associated Press Monday, February 21, 2011 HICKORY, N.C. (AP) The stepmother of a 10 year old disabled girl was indicted Monday on charges she killed the child and then desecrated her remains to cover up the slaying, and authorities said they did not have evidence to charge anyone else in her death. Prosecutor James Gaither Jr. said Monday at a news conference that there was no credible evidence to suggest anyone else was involved in Zahra Baker's slaying. The stepmother, Elisa Baker, was charged earlier Monday with second degree murder. 4

5 Doctor's daughters tell of being confined to garage, mobile home The children of a former Mercy Hospital surgeon, who were removed from his home in New Mexico last week after abuse allegations, are safe with relatives pending the outcome of the case against him and his wife. Pittsburgh Post Gazette Incidence / 1,000 children > 1200 Deaths per year Real Case Day 8 18 mo. old child unwitnessed fall Swollen Rt. foot, large bruise Neg. x rays Bruised Rt. thigh, and Rt. side of chest 5

6 Physical Signs - Skin Bruises Bites Burns Ages, location, patterns Bite on Calf 6

7 Beat with Hair brush Beat with electric cord Finger marks from squeezing 7

8 Hot water burns Ligature marks - restrained R/O Basilar Skull fracture 8

9 Opened Hand Slap Marks Physical Signs - Other Multiple Subdural Hematomas Retinal Hemorrhage Fractures Multiple Different ages Ribs esp. Posterior Retinal Hemorrhage 9

10 Retinal Hemorrhage Retinal Hemorrhage Subdural Hematoma 10

11 High Specificity Fractures Metaphyseal (Corner) Fractures Bilateral Fractures Complex Skull Fractures Different Ages Locations Ribs, Scapula, Lat. Clavicle, Vertebrae RIB FRACTURES RIB FRACTURES 11

12 CORNER FRACTURE CORNER FRACTURE CORNER FRACTURE 12

Abuse and Long Bone Fractures Non Ambulators Poor History Conflicting Histories Delay in Treatment INFANT FEMUR FRACTURE Real Case Day 8 18 mo.

13 Abuse and Long Bone Fractures Non Ambulators Poor History Conflicting Histories Delay in Treatment INFANT FEMUR FRACTURE Real Case Day 8 18 mo. old child unwitnessed fall Swollen Rt. foot, large bruise Neg. x rays Bruised Rt. thigh, and Rt. side of chest Grunting with breathing Looks pale 13

14 Real Case - Day 8 Returned to Pediatrician Sent to ER Chest X ray Large Effusion CBC White Count = 204,000 Differential Diagnosis Osteogenesis Imperfecta Metabolic Bone Disease Accidental Trauma Differential Diagnosis Osteogenesis Imperfecta Metabolic Bone Disease Metabolic Bone Disease Accidental Trauma Leukemia 14

15 Your Job in Abuse Keep Abuse in your Differential Protect the Child Report Suspicious Cases Let DCFS Investigate Sources Jayakumar, P., et. Al, Orthopaedic Aspects of Paediatric Non Accidental Injury. JBJS (Br), 2010; 92 B: Loder, R., Feinberg, J., Orthopaedic Injuries in Children With Non accidental Trauma. J Ped. Orthop. Vol 27, No. 4, Jun 2007, Sources Schwend, R., et. al., Femur Shaft Fractures in Toddlers and Young Children: Rarely from Child Abuse. J Ped. Orthop. Vol 20, No. 4, 2000, Brown, D. and Fisher, E., Femur Fractures in Infants and Young Children. Am J of Pub. Health, Apr 2004, Vol 94 No. 4,

16 Sources Kocher, M., and Kasser, J. Orthopaedic Aspects of Child Abuse. J AAOS, Vol 8, No 1, Feb 2000, US Gov. Web site State of Ill. Web site THANK YOU 16

Evaluation of a Pediatric Patient

September 2005 Evaluation of a Pediatric Patient Percy Ballard, Harvard Medical School Year III Our Little Man: 6mo old male transferred to Children s from hospital in the Philippines 3mo history of meningitis,