II. Indications: Age <24 months
- Confessed abuse or high suspicion for abuse
- Injury during Domestic Violence
- Fracture due to impact from toy or other object
- Delayed presentation >24 hours for a child in obvious distress
- Fracture accompanied by unrelated injury signs (e.g. Bruises, burns)
-
Fracture not explained by Trauma History EXCEPT in ambulatory child >9 months AND
- Distal radius/ulna buckle Fracture (esp. if Fall on Outstretched Hand) OR
- Distal tibia/fibula spiral or buckle Fracture (esp. if fall while Running or walking)
- All children <12 months old with ANY Fracture EXCEPT no additional concerns AND
- Linear, unilateral Skull Fracture in child >6 months and significant fall (e.g. height >3 feet)
- Clavicle Fracture attributable to Birth Trauma
- Acute Clavicle Fracture in child age <22 days old
- Healing Clavicle Fracture in child age <30 days old
- All children 12-23 months old with any of the following Fractures
- Rib Fracture
- Classic methaphyseal Fracture
- Ping-pong or other complex Skull Fracture
- Humerus Fracture due to a short fall (<3 feet) with epiphyseal separation
- Femur Fracture through diaphysis due to fall from any height
III. Imaging: Protocol
- Anteroposterior (AP) Xrays of bilateral Humerus, Forearm, hands
- Anteroposterior (AP) Xrays of bilateral femurs, tib-fib, feet
- Anteroposterior (AP) Xrays of Pelvis (catches mid-Lumbar Spine)
- Cervical Spine lateral xray
- Lumbosacral Spine lateral xray
- Thoracic Spine (lateral as well as AP and obliques to evaluate for Rib Fractures)
- Skull lateral and frontal xray