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Metabolic Bone Disease and Other Alternative Reasons for Fractures

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Recognizing Child Abuse in Radiology

Abstract

Rickets and hyperparathyroidism have been mistaken for abuse, especially when hyperparathyroid-weakened bones fracture; on the other hand, clear radiographic demonstration of abuse has been falsely claimed to be rickets by abuse deniers. The key finding radiographically in rickets is nonmineralization of the cartilaginous zone of provisional calcification. Three key findings of hyperparathyroidism are coarse trabeculae, washing out of tubular bone cortices, and loss of the lamina dura around teeth. In osteoporosis, including from scurvy and copper deficiency, the zone of provisional calcification becomes more conspicuous compared to adjacent demineralized bone. Leukemia and other generalized diseases can be mistakenly considered abuse. Rescue trauma is also in the differential abuse and requires astute questioning of the caretakers.

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References

  1. Bieganski T, Oestreich AE, Nowak S et al (1999) Ebb and flow rickets in a premature infant: the Afghan turban sign. Skeletal Radiol 28:851–854

    Google Scholar 

  2. Lumpkins L, Oestreich AE (1982) Rickets as an unexpected finding. J Natl Med Assoc 75:255–258

    Google Scholar 

  3. Osier LK, Marks SC Jr, Kleinman PK (1993) Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicating healing fractures. J Pediatr Orthop 13:249–254

    CAS  PubMed  Google Scholar 

  4. Brill PW, Baker DH, Ewing ML (1973) Bone-within-bone in the neonatal spine. Stress change or normal development. Radiology 108:363–366

    Article  CAS  PubMed  Google Scholar 

  5. Aryan HE, Ghosheh FR, Jandial R et al (2005) Retinal hemorrhage and pediatric brain injury: etiology and review of the literature. J Clin Neurosci 12:624–631

    Article  PubMed  Google Scholar 

  6. Nadjem H, Sutor AH (1991) Hematoma in acute leukemia – suspected diagnosis of child abuse [in German]. Beitr Gerichtl Med 49:227–231

    CAS  PubMed  Google Scholar 

  7. McClain JL, Clark MA, Sandusky GE (1990) Undiagnosed, untreated acute lymphoblastic leukemia presenting as suspected child abuse. J Forensic Sci 35:735–739

    Article  CAS  PubMed  Google Scholar 

  8. Ved N, Haller JO (2002) Periosteal reaction with normal-appearing underlying bone: a child abuse mimicker. Emerg Radiol 9:278–282

    PubMed  Google Scholar 

  9. Rupprecht E, Berger G (1976) Die klinische und röntgenologische Symptomatik der Kindesvernachlässigung und Kindesmisshandlung. [Clinical and radiographic findings in child neglect and child abuse]. Kinderärtl Praxis 3:113–123

    Google Scholar 

  10. Walsh J, Reardon W (2008) Job syndrome masquerading as non-accidental injury. Arch Dis Child 93:65–67

    Article  CAS  PubMed  Google Scholar 

  11. Rupprecht E, Berger G (1976) Zur Differentialdiagnose des multiplen Skelettraumas im Kindesalter (“battered child syndrome”) [Differential diagnosis of multiple skeletal trauma in childhood]. Radiol Diagn 17:615–625

    CAS  Google Scholar 

  12. Bronicki LM, Stevenson RE, Spanger JW (2015) Beyond osteogenesis imperfecta: causes of fractures during infancy and childhood. Am J Med Genet 169C:314–327

    Article  Google Scholar 

  13. Oestreich AE, Cole CR (2013) Vigorous periosteal reaction secondary to copper deficiency in an infant on total parenteral nutrition. Pediatr Radiol 43:1411–1413

    Article  PubMed  Google Scholar 

  14. Caffey J (1972) The parent-infant traumatic stress syndrome. AJR Am J Roentgenol 114:218–229

    Article  CAS  Google Scholar 

  15. Igual M, Giedion A (1979) [The lateral clavicle hook: its objective measurement and its diagnostic value in diastrophic dwarfism, thrombocytopenia – absent radius syndrome, and trisomy 8] [in French]. Ann Radiol 22:136–141

    CAS  PubMed  Google Scholar 

  16. Kalideen JM, Satyapal KS (1994) Fractures of the acromium in tetanus neonatorum. Clin Radiol 49:563–565

    Article  CAS  PubMed  Google Scholar 

  17. Lopez MR, Abd-Allah S, Deming DO et al (2014) Oral, jaw, and neck injury in infants and children: from abusive trauma or intubation? Pediatr Emerg Care 30:305–310

    Article  PubMed  Google Scholar 

  18. Fauré C, Steadman C, Lalande G et al (1979) La Vertèbre Vagabonde [The wandering vertebral body] [in French and English]. Ann Radiol 22:96–99

    PubMed  Google Scholar 

  19. Oestreich AE (2015) Concave distal end of ulna metaphysis alone is not a sign of rickets. Pediatr Radiol 45:998–1000

    Article  PubMed  Google Scholar 

  20. Fraenkel E, Lorey A (1910) Die Rachitis im Röntgenbild. Grafë & Sillem, Hamburg

    Google Scholar 

  21. Oestreich AE (2008) Growth of the pediatric skeleton. Springer, Berlin

    Google Scholar 

  22. Oestreich AE, Ahmad BS (1993) The periphysis and its effect on the metaphysis. II application to rickets and other abnormalities. Skeletal Radiol 22:115–119

    Article  CAS  PubMed  Google Scholar 

  23. Resnick D, Niwayama G (1988) Diagnosis of bone and joint disorders, 2nd edn. Saunders, Philadelphia

    Google Scholar 

  24. Wimberger H (1925) Klinisch-radiologische Diagnostik von Rachitis, Skorbut und Lues congenita in Kindesalter. Ergeb Inn Med Kinderh 28:264–370

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology ML5031, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA

    Alan E. Oestreich & Marguerite M. Caré

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  1. Alan E. Oestreich
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  2. Marguerite M. Caré
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Oestreich, A.E., Caré, M.M. (2017). Metabolic Bone Disease and Other Alternative Reasons for Fractures. In: Recognizing Child Abuse in Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-44324-9_4

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  • DOI: https://doi.org/10.1007/978-3-319-44324-9_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44322-5

  • Online ISBN: 978-3-319-44324-9

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