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Materia Medica

Rickets vs. abuse: a national and international epidemic
Kathy A. Keller, Patrick D. Barnes 

This commentary article regarding Rickets and child abuse appears in Pediatric Radiology. In summary, key facts that would support the defense in a child abuse case are:

  • Bone changes can be subtle in early infancy.
    • An inexperienced radiologist may miss Rickets on Xray.
  • Differentiating between rib fractures and “Looser Zones” (pseudofractures seen in Rickets) on xray may be difficult.
    • This would equate to a misdiagnosis of rib fractures in a child with Rickets.
  • Timing of fractures in Rickets is impossible – it can only be assumed that healing will be delayed.
    • Multiple Fractures in various stages of healing may all be from the same event and longer ago than originally thought if a diagnosis of Rickets is made.
  • Bone Density Studies are unreliable in infants under 6 months of age.
    • You can’t tell on xray if the bones are weak until after 6 months.

Keller, K. A., & Barnes, P. D. (2008). Rickets vs. abuse: a national and international epidemic. Pedatric Radiology.

Full text available online: http://www.stanford.edu/~pbarnes/docs/publications/Rickets_Abuse.pdf

 

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