Pediatric Radiology

, Volume 46, Issue 5, pp 591–600 | Cite as

The etiology and significance of fractures in infants and young children: a critical multidisciplinary review

  • Sabah Servaes
  • Stephen D. Brown
  • Arabinda K. Choudhary
  • Cindy W. Christian
  • Stephen L. Done
  • Laura L. Hayes
  • Michael A. Levine
  • Joëlle A. Moreno
  • Vincent J. Palusci
  • Richard M. Shore
  • Thomas L. Slovis


This paper addresses significant misconceptions regarding the etiology of fractures in infants and young children in cases of suspected child abuse. This consensus statement, supported by the Child Abuse Committee and endorsed by the Board of Directors of the Society for Pediatric Radiology, synthesizes the relevant scientific data distinguishing clinical, radiologic and laboratory findings of metabolic disease from findings in abusive injury. This paper discusses medically established epidemiology and etiologies of childhood fractures in infants and young children. The authors also review the body of evidence on the role of vitamin D in bone health and the relationship between vitamin D and fractures. Finally, the authors discuss how courts should properly assess, use, and limit medical evidence and medical opinion testimony in criminal and civil child abuse cases to accomplish optimal care and protection of the children in these cases.


Child abuse Children Fractures Infants Metabolic bone disease Non-accidental trauma Radiography Rickets Vitamin D 


Compliance with ethical standards

Conflicts of interest

Dr. Christian and Dr. Palusci provide medico-legal expert work in child abuse cases. All other authors have no disclosures.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sabah Servaes
    • 1
  • Stephen D. Brown
    • 2
  • Arabinda K. Choudhary
    • 3
  • Cindy W. Christian
    • 4
  • Stephen L. Done
    • 5
  • Laura L. Hayes
    • 6
  • Michael A. Levine
    • 4
  • Joëlle A. Moreno
    • 7
  • Vincent J. Palusci
    • 8
  • Richard M. Shore
    • 9
  • Thomas L. Slovis
    • 10
  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of RadiologyBoston Children’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of Medical ImagingAlfred I. duPont Hospital for ChildrenWilmingtonUSA
  4. 4.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Department of RadiologySeattle Children’s HospitalSeattleUSA
  6. 6.Department of RadiologyChildren’s Healthcare of AtlantaAtlantaUSA
  7. 7.Florida International University College of LawMiamiUSA
  8. 8.Department of PediatricsNew York University School of MedicineNew YorkUSA
  9. 9.Department of Medical ImagingNorthwestern University Feinberg School of MedicineChicagoUSA
  10. 10.Department of RadiologyWayne State University School of Medicine and Children’s Hospital of MichiganDetroitUSA

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