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Long arm cast with the elbow in neutral position
1%
12/2118
Bone scan and liver enzymes
14/2118
Notification of hospital child protective services and a skeletal survey
97%
2051/2118
Genetic testing to evaluate for chromosomal translocation
27/2118
Sling and discharge home with follow-up in one week
0%
1/2118
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Figure A shows a distal humeral physeal separation. Figure B depicts a healing left femur fracture. In the pediatric population, these findings are highly suggestive of child abuse. As such, management should include notification of hospital Child Protective Services (CPS) and a skeletal survey. Kocher et al identified patterns suggestive of child abuse. They noted metaphyseal lesions, posterior rib fractures, long bone fractures in non-ambulatory children, and multiple fractures in various stages of healing as being highly suggestive of non-accidental trauma. Workup includes a skeletal survey to rule out other fractures, ophthalmologic examination to rule out retinal hemorrhage (suggestive of intracranial trauma/traumatic brain injury), evaluation for osteogenesis imperfecta when suspected, and further imaging such as bone scan if the skeletal survey is negative but examination remains suspicious.
4.2
(23)
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