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  • Cited by 5
  • Print publication year: 2015
  • Online publication date: September 2015

Chapter 2 - Skeletal trauma: general considerations

from Section I - Skeletal trauma
    • By Paul K. Kleinman, Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA, Andrew E. Rosenberg, Director of Anatomic Pathology and Director of Bone and Soft Tissue Pathology at the University of Miami Hospital and Professor of Pathology at the University of Miami Miller School of Medicine, Miami, Florida, USA, Andy Tsai, Staff Pediatric Radiologist at Boston Children’s Hospital and Instructor in Radiology at Harvard Medical School, Boston, Massachusetts, USA
  • Edited by Paul K. Kleinman
  • Publisher: Cambridge University Press
  • DOI:
  • pp 23-52



Fractures are common injuries in abused children, second only to cutaneous bruising (1). Although fundamental to the documentation of abuse, the fractures are rarely life-threatening and few result in long-term deformity. Specific types of fractures are known to be associated with abuse, and their recognition is important for their accurate identification and in understanding their significance.

Many reports of unexplained subdural hematomas (SDHs) in infants had appeared before Caffey’s historic 1946 article, but it was only after he associated these lesions with certain patterns of skeletal injury that the modern medical entity of child abuse was formulated (2). In a sense, recognition of the role of skeletal injuries in child abuse became the catalyst for the surge of interest in child maltreatment after Caffey’s original description.

In the years that followed, most reports of child abuse focused mainly on the radiologic alterations associated with the skeletal trauma (3–14). The confident documentation of skeletal injury, facilitated by characteristic radiologic alterations, provided investigators the opportunity to study the multiple facets of child abuse. Eventually, the blend of the clinical and the radiologic findings led Kempe, Silverman, and others to bring these associations to the status of the “battered child syndrome” (15).

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