BODYCAST
- THE OFFICIAL JOURNAL OF THE CSOT
Differential diagnosis -
Child abuse or bone disorder
By Bradley DeWagner RT(Orthopaed)
A child is seen in the emergency room with a fractured femur.
The parents cannot explain how this may have happened.
X-rays also reveal several rib fractures that the parents claim to
know nothing about. Allegations begin, pressure to "fess up" is
applied by staff members and shortly thereafter someone from
child services appears and wishes to speak with the parents
in private. They are no longer allowed to sit with their crying
child. The wheels are in motion.
Explaining the injury of a child can be a simple task - they
fell off their bike, a sibling tripped them. The scenarios are
endless. It can also, at times, not be simple at all. The string
of events that can follow an unexplained injury - a fracture of
a large bone, of a skull, or a fracture accompanied by other
fractures that appear during routine examination that the
parents cannot explain - can put in motion a devastating string
of events that can culminate with a report to children's service.
Allegations of child abuse, a child and siblings being removed
from the parents care and placed in foster care. A nightmare
set in motion unexpectedly. The orthopaedic technologist is
one piece of the puzzle along with other health care providers
who may help a diagnosing physician put together those
pieces of the puzzle that may provide a definitive conclusion
regarding non-accidental injury or bone
disorder. The orthopaedic technologist has
a very hands-on, interpersonal relationship
with his patients and families. Although
a thorough examination by a physician
should reveal any suspect signs of non-accidental injury such as bruising, burns,
or linear marks suggesting non-accidental
injury, the extra pair of eyes and ear of the
orthopaedic technologist or nurse, along
with their assessment skills, can often
provide a clearer picture for the diagnosing
physician to accompany his/her assessment
and diagnostic findings.
This abstract is a portion of the article
which appears in the Summer 2011 issue of BodyCast.
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