Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review

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dc.contributor.authorPandya, N. K., Baldwin, K., Kamath, A. F., Wenger, D. R., & Hosalkar, H. S.
dc.date.accessioned2017-01-26T14:30:21Z
dc.date.available2017-01-26T14:30:21Z
dc.date.issued2011
dc.description.abstractBackground: Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN. Questions/purposes: We therefore (1) determined which bone diseases most commonly mimic CAN; (2) what types of osteogenesis imperfecta (OI) are most commonly confused with CAN and why; and (3) what specific findings in OI and bone disease render a mistaken diagnosis of CAN more likely. Methods: A systematic review of the literature was performed. We identified studies that compared cases of CAN with cases in which patients had bone disease that resulted in an unexplained fracture. We also included studies in which patients with fractures resulting from underlying bony pathology were misclassified as CAN and were subsequently reclassified as bone disease as a result of further investigation. Our search netted only five studies that directly compared and contrasted CAN with metabolic or genetic bone disease in the same study. Results: The published literature suggests OI is most frequently confused with CAN, although metaphyseal dysplasia, disorders of phosphate metabolism, and temporary brittle bone disease are also documented in the literature identified by our search. Difficulty in differentiating these bony diseases from CAN stems from ambiguity in the history and physical examination at the time of presentation. Conclusions: Bone disease is a diagnosis of exclusion in the differential diagnosis of CAN. (Author Abstract)en_US
dc.identifier.citationPandya, N. K., Baldwin, K., Kamath, A. F., Wenger, D. R., & Hosalkar, H. S. (2011). Unexplained fractures: child abuse or bone disease? A systematic review. Clinical Orthopaedics and Related Research®, 469(3), 805-812.en_US
dc.identifier.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032841/pdf/11999_2010_Article_1578.pdf  
dc.identifier.urihttp://hdl.handle.net/11212/3184
dc.language.isoenen_US
dc.publisherClinical Orthopaedics and Related Researchen_US
dc.subjectchild abuseen_US
dc.subjectdiagnosisen_US
dc.subjectphysical examinationen_US
dc.subjectindicationsen_US
dc.subjectliterature reviewen_US
dc.titleUnexplained Fractures: Child Abuse or Bone Disease? A Systematic Reviewen_US
dc.typeArticleen_US

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