Published 28 October 2008, doi:10.1136/bmj.a2279
Cite this as: BMJ 2008;337:a2279

Letters

Patterns of skeletal fractures in child abuse

"Unexplained" fractures

The first 150 words of the full text of this article appear below.

The systematic review by Kemp et al of skeletal fractures in children and the accompanying editorial gloss over the substantial medical uncertainties in this area that result in parents being wrongfully accused of injuring their children.1 2 It might seem self evident that deliberately inflicted injury must be the probable cause of an "unexplained" fracture—where "unexplained" in this context means there is no plausible history of accidental trauma. and those conditions that predispose to bone fragility—such as osteogenesis imperfecta—have been excluded.

The uncertainty arises in that unexplained category where there is a marked discrepancy between the clinical presentation of the child and purported abusive nature of the fracture: where the child appears well cared for by responsible parents and with no circumstantial evidence in the form of bruising or soft tissue swelling that would be expected were he or she the victim of physical assault. This discrepancy is particularly apparent in . . . [Full text of this article]

James R Le Fanu, general practitioner1, Rosemary Neary2, Denise Bartlett2

1 Mawbey Brough Health Centre, London SW8 2UD, 2 Eaton Foundation, Wisbech, Cambs PE14 8TP

james.lefanu@btinternet.com


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Rapid Responses:

Read all Rapid Responses

Unexplained Fractures
Peter Ehrhardt
bmj.com, 4 Nov 2008 [Full text]
Re: Unexplained Fractures - Explained
Michael D Innis
bmj.com, 6 Nov 2008 [Full text]
"Unexplained" fractures
John W Puntis
bmj.com, 12 Nov 2008 [Full text]
unexplained fractures
Peter Ehrhardt
bmj.com, 13 Nov 2008 [Full text]
Re: "Unexplained" fractures - Explained
Michael D Innis
bmj.com, 13 Nov 2008 [Full text]
Re: Re: "Unexplained" fractures - Explained
Alison Jayne Stevens
bmj.com, 9 Dec 2008 [Full text]
'Unexplained' fractures explained
Dr Viera Scheibner PhD
bmj.com, 12 Dec 2008 [Full text]
Our tunnel view may miss a child abuse
Khalid Alkhouly
bmj.com, 16 Dec 2008 [Full text]
When to suspect child maltreatment
Theo Fenton
bmj.com, 17 Dec 2008 [Full text]
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