II. Indications: Age <24 months

  1. Confessed abuse or high suspicion for abuse
  2. Injury during Domestic Violence
  3. Fracture due to impact from toy or other object
  4. Delayed presentation >24 hours for a child in obvious distress
  5. Fracture accompanied by unrelated injury signs (e.g. Bruises, burns)
  6. Fracture not explained by Trauma History EXCEPT in ambulatory child >9 months AND
    1. Distal radius/ulna buckle Fracture (esp. if Fall on Outstretched Hand) OR
    2. Distal tibia/fibula spiral or buckle Fracture (esp. if fall while Running or walking)
  7. All children <12 months old with ANY Fracture EXCEPT no additional concerns AND
    1. Linear, unilateral Skull Fracture in child >6 months and significant fall (e.g. height >3 feet)
    2. Clavicle Fracture attributable to Birth Trauma
      1. Acute Clavicle Fracture in child age <22 days old
      2. Healing Clavicle Fracture in child age <30 days old
  8. All children 12-23 months old with any of the following Fractures
    1. Rib Fracture
    2. Classic methaphyseal Fracture
    3. Ping-pong or other complex Skull Fracture
    4. Humerus Fracture due to a short fall (<3 feet) with epiphyseal separation
    5. Femur Fracture through diaphysis due to fall from any height

III. Imaging: Protocol

  1. Anteroposterior (AP) Xrays of bilateral Humerus, Forearm, hands
  2. Anteroposterior (AP) Xrays of bilateral femurs, tib-fib, feet
  3. Anteroposterior (AP) Xrays of Pelvis (catches mid-Lumbar Spine)
  4. Cervical Spine lateral xray
  5. Lumbosacral Spine lateral xray
  6. Thoracic Spine (lateral as well as AP and obliques to evaluate for Rib Fractures)
  7. Skull lateral and frontal xray

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