Physical abuse in children often remains undetected. Atypical fractures may indicate such abuse. Everything that doctors should be particularly alert to and aware of in this setting is the subject of an article by Oliver Berthold and colleagues in the current issue of the Deutsches Ärzteblatt International (Dtsch Arztebl Int 2018, 115: 769-75). Fractures due to abuse are especially common among infants. In babies younger than 6 months, about 57 in every 100,000 are affected. At the age of 6-11 months, the incidence is 40/100,000 children.
The authors found that it isn't always easy or straightforward to distinguish inflicted fractures from accidental fractures. According to a recent study, fractures were confirmed to be inflicted in 31 of a total of 551 children.
The doctors providing initial care carry a particular responsibility in the setting of child abuse, because abuse if often repeated and affected children often die from the consequences. Berthold et al. postulate that every doctor who treats children at least occasionally should be familiar with the crucial indicators for fractures as a result of physical abuse, as well as with the available advice centers and intervention options.