Introduction
Bode-Jänisch et al. (2012) states that ‘trauma is the leading cause of death in children, and non-accidental head injury is the leading cause of traumatic death during infancy’. While referral through Social Services is the most common presentation of the child with suspected non accidental injury (Speight, 2006), the emergency department sees children with all manner of injury, both accidental and non-accidental and it is crucially important that emergency department staff maintain a healthy suspicion and are sufficiently knowledgeable to be able to identify signs of physical abuse and to appropriately manage such cases (Conway, 2008). The correct diagnosis of non-accidental injury may be the difference between life and death for a child and can have a …show more content…
This is usually a spiral fracture resulting from a rotational force applied when the child is pulled by the limb. Rib fractures are rare in young children due to their tendency to bend under force. The mechanism of injury resulting in fractured rib is usually where the person inflicting the injury seizes the child with both hands around the rib cage and exerts significant force causing a fracture or fractures to the ribs, usually posteriorly. Rib fractures may not be seen initially on film unless there is displacement or where callus formation has begun, indicating that the fracture is not new (Sprigg, 2008). Where soft callus formation is seen on x-ray, this indicates that the fracture is between two and three weeks old and should immediately raise suspicions of physical abuse (Greaves and Johnson, 2002). Carty and Pierce (2002) found that in 11 children suspected of suffering abuse, a single rib fracture was the only fracture found in addition to other clinical signs of abuse, demonstrating the importance of further investigation of rib fractures in young