FRACTURES OF THE HANDS AND FEET IN CHILD-ABUSE - IMAGING AND PATHOLOGICAL FEATURES

PURPOSE: To determine the imaging and histopathologic appearance of fr actures of the hands and feet in abused infants. MATERTALS AND METHODS : The imaging findings in 11 abused infants with fractures of the hand s and feet were examined retrospectively. All 11 infants underwent ske letal surveys; five infants also underwent nuclear bone scanning. Post mortem radiographs of the specimen and histopathologic data were avail able in two infants. RESULTS: A total of 22 fractures were noted. Six infants had fractures of the hands: six metacarpal and nine proximal p halangeal fractures. Five infants had fractures of the feet: six metat arsal fractures and one proximal phalangeal fracture. Torus fractures predominated, and these patterns were confirmed at the histologic exam inations. These morphologic features were consistent with a mechanism of forced hyperextension. Oblique views of the hands and follow-up ske letal surveys aided in detection of these injuries. Four of six metata rsal fractures involved the first ray. Seven patients had three or mor e additional fractures that involved the long bones of the upper and l ower extremities, and seven patients had additional fractures of the i psilateral extremity. CONCLUSION: Fractures of the hands and feet are subtle but important injuries in abused infants. Well-collimated, high -detail radiographs of the hands and feet should be included in the sk eletal survey performed for suspected child abuse.