Paeds Vivas · child-safety-and-social-paediatrics
Inflicted fractures and other non-accidental musculoskeletal injury — branching viva
Branching viva on the high-specificity fracture patterns, the shearing biomechanics of the classic metaphyseal lesion and the lever mechanism of the posterior rib fracture, the mandatory skeletal-survey protocol with the follow-up survey, the rickets and osteogenesis-imperfecta differentials, and the safeguarding conversion in a pre-mobile infant with a spiral femur fracture.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the general paediatrician assessing a six-month-old who cannot yet crawl, presenting with a spiral femur fracture and an implausible history. The examiner will test the specificity ladder, the biomechanics of the classic metaphyseal lesion and the posterior rib fracture, the skeletal-survey protocol with the follow-up survey, the differentials, and the safeguarding conversion.
Stem
The examiner opens with a six-month-old, pre-mobile infant and a spiral femur fracture, then escalates through the specificity ladder, the biomechanics, the skeletal-survey protocol, the differentials, and a safeguarding conversion when an occult rib fracture emerges. [1] [10]
References8ShowHide
- [1]Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, Datta S, Thomas DP, Sibert JR, Maguire S Patterns of skeletal fractures in child abuse: systematic review. BMJ, 2008.PMID 18832412
- [3]Lonergan GJ, Baker AM, Morey MK, Boos SC From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics, 2003.PMID 12853657
- [7]Tsai A, Coats B, Kleinman PK Biomechanics of the classic metaphyseal lesion: finite element analysis. Pediatr Radiol, 2017.PMID 28721473
- [6]Maguire S, Mann M, John N, Ellaway B, Sibert JR, Kemp AM Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review. Child Abuse Negl, 2006.PMID 16857258
- [10]Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio R, Feudtner C Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatr, 2014.PMID 24989500
- [14]Harper NS, Lewis T, Eddleman S, et al. Follow-up skeletal survey use by child abuse pediatricians. Child Abuse Negl, 2016.PMID 26342432
- [8]Perez-Rossello JM, McDonald AG, Rosenberg AE, Tsai A, Kleinman PK Absence of rickets in infants with fatal abusive head trauma and classic metaphyseal lesions. Radiology, 2015.PMID 25688889
- [4]Section on Radiology, American Academy of Pediatrics Diagnostic imaging of child abuse. Pediatrics, 2009.PMID 19403511