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Long bone fracture detection in suspected child abuse: contribution of lateral views

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Abstract

Background

ACR guidelines for routine skeletal survey for child abuse recommend only AP radiographs of the long bones; however, many institutions add lateral radiographs.

Objectives

To evaluate whether adding lateral radiographs for long bones changes the frequency and confidence of fracture detection in skeletal survey radiographs for suspected abuse.

Materials and methods

We identified 100 children younger than 2 years of age who underwent skeletal survey for child abuse; 56 with multiple long bone fractures, 22 with a single fracture and 22 with no fractures. Four radiologists (two pediatric radiologists, one pediatric radiology fellow and one general radiologist) evaluated two randomized series (one series included only frontal, and the other series, frontal and lateral radiographs). Likert scale of 1–5 was used to score for detection of metaphyseal and diaphyseal fractures.

Results

For combined readers, significantly more metaphyseal fractures (P = 0.01) were detected with the two-views series of radiographs compared with the frontal-only view; there was no significant difference for diaphyseal fractures. Confidence was also significantly higher for the two-views series. Kappa improved (from 0.32 to 0.48) when the lateral view was added only for the metaphyseal fractures.

Conclusion

Adding lateral radiographs resulted in increased detection and confidence levels of metaphyseal fractures.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA

    Boaz Karmazyn & Matthew R. Wanner

  2. Kalamazoo Division, Advanced Radiology Services, Kalamazoo, MI, USA

    Ryan D. Duhn

  3. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA

    S. Gregory Jennings & Bilal Tahir

  4. Department of Pediatrics, Section of Child Protection Programs, Indiana University School of Medicine, Indianapolis, IN, USA

    Roberta Hibbard & Ralph Hicks

Authors
  1. Boaz Karmazyn
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  2. Ryan D. Duhn
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  3. S. Gregory Jennings
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  4. Matthew R. Wanner
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  5. Bilal Tahir
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  6. Roberta Hibbard
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  7. Ralph Hicks
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Corresponding author

Correspondence to Boaz Karmazyn.

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Karmazyn, B., Duhn, R.D., Jennings, S.G. et al. Long bone fracture detection in suspected child abuse: contribution of lateral views. Pediatr Radiol 42, 463–469 (2012). https://doi.org/10.1007/s00247-011-2248-3

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  • DOI: https://doi.org/10.1007/s00247-011-2248-3

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