what-when-how
In Depth Tutorials and Information
FIGURE 42.3
(a) Thirty-three-day-old with history of “RT arm pulled.” Acute spiral fracture mid humerus shaft. (b) Two-month-old with
decreased movement LT upper extremity. Healing fractures distal radius and ulna shafts and proximal radius shaft.
though infrequent, is a highly specific fracture of NAT,
occurring from vigorous shaking with secondary avul-
sion of the acromion process from stress on the deltoid
ligament (
Figure 42.4
).
7
While intracranial injuries are more devastating, they
are less common, constituting 10-12% of abusive inju-
ries. The most common intracranial injury is subdural
hemorrhage, due to shaking without or with impact
resulting in skull fracture (
Figure 42.5a,b,c
).
24
Shear
injury to the brain is a common presentation of intracra-
nial injuries, which are often accompanied by bilateral
or unilateral retinal hemorrhages. More recently, atten-
tion has been directed at cervical spine injuries, which
may accompany intracranial hemorrhage.
25
Visceral
injuries occur in 2-11% of victims of NAT.
26
They are
usually due to blunt abdominal trauma. The liver is
the most common organ affected, occurring in 43% of
abdominal injuries (
Figure 42.5d
).
27
Retinal hemorrhages are cardinal findings in NAT.
Retinal hemorrhages can be seen in OI, although they
occur infrequently when compared to NAT, are rela-
tively few in number and are located at the posterior
pole. Physicians charged with distinguishing OI and
NAT should consider not only other potential causes for
retinal hemorrhages (sepsis, coagulopathy, vasculitis)
but also should evaluate the patient's full clinical picture
at presentation including the patient's history of trauma
and prior illness in order to arrive at the most appropri-
ate diagnosis. Ganesh et al. reported three patients with
type I OI who developed retinal hemorrhages and sub-
dural hematomas following reportedly minor trauma.
28
However, the authors state that minor falls and blows
do not cause retinal hemorrhages unless there is a severe
and life-threatening brain injury. Although emphasizing
FIGURE 42.4
Four-month-old with acute LT acromion fracture
found on skeletal survey done because of RT leg swelling.
minor injury, the issue of child abuse was not fully
excluded in these three patients (editor's note).
CLINICAL AND RADIOLOGIC
DIFFERENCES BETWEEN OI AND NON-
ACCIDENTAL TRAUMA
The infant and child with OI often present with
subtle signs of the diagnosis which nevertheless can be
