Patterns of injury and significance of uncommon fractures in the battered child syndrome

The classic X ray and clinical features of the battered child syndrome were not present in most of these patients. The well known epiphyseal metaphyseal long bone fractures, usually considered the classic findings in these infants, were less common than were spiral and transverse fractures of the long bones. Multiple skeletal injuries were also less common than expected. It is not known whether these data merely represent an isolated experience, or a more universal, but as yet unappreciated phenomenon. However, these findings caused the authors to place more emphasis on and to be more suspicious of single, ordinary long bone fractures, especially when clinical correlation is less than plausible. Skull fractures and spread of the cranial sutures, either alone or in combination, were quite common. These findings are obviously significant both in respect to early diagnosis and associated intracranial complications. Often skull fractures, or simple spreading of the sutures, served to focus more attention on otherwise innocuous appearing, but concurrent, spiral or transverse long bone fractures. Certain less common fractures found were felt to be highly suspicious, and might even be considered as valuable a sign of the battered child syndrome as the typical epiphyseal metaphyseal long bone fracture. The most notable of these were fractures of the lateral end of the clavicle and fractures of the ribs and scapula. Less often, sternal and spinal fractures were useful. It is believed that although these fractures are less common, their appreciation should aid the radiologist in diagnosing cases which might otherwise pass unrecognized for considerable periods of time.