n South African Journal of Child Health - Fracture patterns in non-accidentally injured children at Red Cross Children's Hospital




Unexplained fractures in infants and children often suggest abuse. Head injury with concomitant skull fracture is the leading cause of death in cases of child abuse. Fractures associated with child abuse vary from 11% to 55% in non-accidental injury (NAI) presentations. Distinguishing accidental from abusive fractures is vital; failure to recognise and prevent further abuse may result in unnecessary psychological trauma, injury or death of the child. The fracture patterns with high specificity for abuse are well documented; however, in practice, these patterns occur infrequently, and abused children may present with a wide spectrum of bony injuries. The majority of reports suggest that fractures of long bones are those most frequently seen in cases of abuse, although some studies have reported higher numbers of skull and rib fractures. Furthermore, socio-economic factors have been reported to influence the incidence and pattern of injuries in child abuse. The present study was a retrospective review of the Child Accident Prevention Foundation of South Africa (CAPFSA) database of children seen over a 14-year period at Red Cross War Memorial Children's Hospital (RXH), Cape Town, to identify those who had sustained fractures as a result of child abuse.


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