PATTERNS OF OSSEOUS INJURIES AND PSYCHOSOCIAL FACTORS AFFECTING VICTIMS OF CHILD ABUSE

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Abstract
The aim of this paper is to document experience in the management of cases of child abuse with suspected osseous injury, at the Adelaide Children''s Hospital, during the period January 1974-December 1986. The study is a retrospective review of the casenotes, radiographs and radiologists'' report of 108 consecutive cases with suspected osseous injuries. Information regarding the osseous injuries sustained and the psychosocial environment surrounding the circumstances of the patients admitted was recorded. Of 108 cases of suspected osseous injuries, 90% had confirmed osseous injury, of whom 56 cases (52%) had multiple fractures. Twenty of the 41 cases of single osseous injury were due to skull fractures. In children less than 12 months of age, long bone injuries were the most common form of presentation, and in 83% of these the injuries were multiple. Metaphyseal injury in association with other fractures was present in 14% of cases, and 8% of cases showed evidence of periosteal reaction to injury. There were two deaths during the period of this study, as a direct consequence of abuse. The main cause of death in both of these cases was the combination of cerebral haemorrhage and liver trauma. There were 10 other deaths not associated with fracture during this period. The analysis of psychosocial factors demonstrated that 48% of the children were first-born and 67% of parents were unemployed. Of the alleged abuser, the mother was known to be responsible in 50% of cases. In 10% of cases, the parent responsible for the injury admitted to the offence at the time of presentation at the hospital. Of the 48 cases that presented again with a further non-accidental injury, 11 children were reinjured despite being seconded to foster homes, and the remaining 37 children suffered further abuse of different degrees after being returned to the homes of their biological parents.

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