Alternative methods of investigation may be more appropriate When radiological investigation of occult fractures is warranted (seeĭiscussion below for additional information in relation to this VFPMS recommends using skeletal survey and bone scan When known fracture prompts investigations for additional occult Guidelines for Skeletal Survey in Young Children With Bruises. MVC or fall in public place), do not have underlying bleeding disorder such as haemophilia, and who do not have a clear history of birth trauma that accounts for the injury. These guidelines apply to children who do not have a verifiable mechanism of accidental injury (i.e. Bony prominences (head T-shaped area, frontal scalp, extremity bony prominences) EXCEPT if a single bruise and patient presents with history of fall.Skeletal survey is also necessary in children <6 months old with bruising in the following locations: Skeletal survey is also necessary in children 1 bruise in ANY location Skeletal survey is also necessary in children 1 bruise NOT limited to bony prominences Ear, neck, torso, buttock, genital region, hands, feet if there is no history of trauma.If child is 4 bruises NOT limited to bony prominences.Serum levels of calcium, phosphate and alkaline phosphatase.Laboratory investigations for underlying medicalĬauses of fractures First line investigations Many children with fractures will have minimal or no.Multiple fractures and/or fractures of different ages generate.Certain skull fractures are concerning for abuse (see VFPMS.Significant concern for an abusive cause (specifically posteromedial ribįractures and metaphyseal corner fractures). Certain locations and types of fractures generate.No specific fracture type is pathognomonic for abuse.In infants, fractures are more commonly attributed to abuse.All fractures in non-ambulatory children are concerning for.Occult (hidden)įractures should be actively investigated as discussed here (with a link to lowerĭown on the page on investigation of occult fractures). Most often occur in pre-verbal and non-ambulatory infants. These inflicted fractures are not clinically suspected primarily because they Fractures are the second most common injury caused by RCH Clinical Practice Guideline Paediatric Fractures VFPMS Guideline: Forensic investigation of fracturesĪ fracture is a complete or incomplete break in theĬontinuity of a bone.
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