Non-accidental Injury

Radiographs are likely to be the first imaging method used following trauma, and the first to lead to legal action if omitted or misinterpreted. Standard (plain film) radiography is the method most often relied upon in the assessment of suspected non-accidental injury of children. It is important that good quality radiographs are obtained in all circumstances and... 

The demands on image quality can vary depending on the clinical situation. The resolution required for a survey for non-accidental injury is particularly demanding of a digital system, as it is for standard film radiography, as the target lesions are small and subtle. 

Musculoskeletal injuries in children fall into three main groups Accidental trauma such as road traffic accidents and falls, non-accidental injury (NAl) and sport related injury. For each of these groups specific injury patterns can be recognised that are unique to the growing skeleton. 

Role of Bone scintigraphy in Paediatric Trauma 82 Non-accidental Injury 85 Stress Fractures 85 Appendicular 85 Spine 85... 

A skeletal survey is accepted standard practice in the investigation of non-accidental injury. Scintigraphy is more sensitive than plain films in the diagnosis of fractures, particularly in difficult areas such as the ribs. Where there is diagnostic difficulty or dispute on the findings of the radiograph which would have significant implication on either the civil or the criminal procedures, a bone scan is justified (Sty and Starshak 1983 Pickett et al. 1983 Smith et al. 1980) (Fig. 6.3). 

Fig. 7.11. Manubrium and sternal ossification centres projected over the ribs taken in oblique projection as part of a skeletal survey in suspected non-accidental injury (arrows)...

Radiologists have a critical role in identifying children who have been injured, particularly intentionally injured, and who may he injured further if the correct diagnosis of non-accidental injury is not made and the child returned to the care of the perpetrator. The radiologist s roles are listed in Table 11.1. 

As Caffey originally pointed out, metaphyseal fractures are the result of tractional and torsional forces applied to a limb. This can occur when a limb is used as a handle or when centrifugal forces act during violent shaking. Rarely, an isolated metaphyseal fracture maybe found and correlated with a plausible accidental event. However, in all other circumstances this injury in an otherwise normal child is virtually diagnostic of non-accidental injury. 

Table 11.4. Differential diagnoses of the bony lesions in non-accidental injury...

Ablin DS, Sane SM (1997) Non-accidental injury confusion with temporary brittle bone disease and mild osteogenesis imperfecta. Pediatr Radiol 27 111-113... 

Anderson WA (1982) The significance of femoral fractures in children. Ann Emerg Med 11 174-177 Anilkumar A, Fender LJ, Broderick NJ et al (2006) The role of the follow-up chest radiograph in suspected non-accidental injury. Pediatr Radiol 36 216-218 AstleyR (1979) Metaphyseal fractures in osteogenesis imperfecta. Br J Radiol 52 441-443... 

Caffey J (1957) Some traumatic lesions in growing bones other than fractures and dislocations clinical and radiological features. Br J Radiol 30 225-238 Carty H (1988) Brittle or battered. Arch Dis Child 63 350-352 Carty H, Pierce A (2002) Non-accidental injury a retrospective analysis of a large cohort. Eur Radiol 12 2919-2925 Carty H, Shaw D (1988) Osteogenesis imperfecta type IV A. 

Chapman S, Hall CM (1997) Non-accidental injury or brittle bones. Pediatr Radiol 27 106-110 Crilly R (1972) Longitudinal overgrowth of the chicken radius. J Anat 112 11-18... 

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