Fractures of the hands and feet in child abuse: Imaging and pathologic features

PURPOSE: To determine the imaging and histopathologic appearance of fractures of the hands and feet in abused infants. MATERIALS AND METHODS: The imaging findings in 11 abused infants with fractures of the hands and feet were examined retrospectively. All 11 infants underwent skeletal surveys; five infants also underwent nuclear bone scanning. Postmortem radiographs of the specimen and histopathologic data were available in two infants. RESULTS: A total of 22 fractures were noted. Six infants had fractures of the hands: six metacarpal and nine proximal phalangeal fractures. Five infants had fractures of the feet: six metatarsal fractures and one proximal phalangeal fracture. Torus fractures predominated, and these patterns were confirmed at the histologic examinations. These morphologic features were consistent with a mechanism of forced hyperextension. Oblique views of the hands and follow- up skeletal surveys aided in detection of these injuries. Four of six metatarsal fractures involved the first ray. Seven patients had three or more additional fractures that involved the long bones of the upper and lower extremities, and seven patients had additional fractures of the ipsilateral 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 skeletal survey performed for suspected child abuse.