Skeletal injuries (fractures) are caused by a sudden injury that exerts more force on the bone than it
can withstand. The force can be a direct blow or a twisting action. A fracture should be considered
suspicious when:
- It is accidently found on examination
- The injury is inconsistent with the history given
- The date does not match the time the caretaker says it occurred
- Multiple fractures are symmetrical and in different stages of healing
- Other injuries are present to other parts of the body
Rib – Most often caused by excessive squeezing
Humerus – Generally caused by indirect twisting or pulling by grabbing the upper arm
Femur– Frequently found in intentional injuries Hands – Can be caused by the victim repeatedly pounding on walls or furniture, indicating neglect or
by direct blows related to corporal punishment
Radius and Ulna (lower arm) – Can be caused by direct impact in attempting to block blows
Other potential physical indications of abuse:
- Contractures (can indicate long-term confinement)
- Dilated pupils
- Frequent falls
- Glasses or frames broken
- Hair thin, as though pulled out
- Pinch marks
- Puncture wound
- Scratches
- Sudden weight loss/gain
- Tremors
NOTE: The presence of one of the injuries described above means that abuse might have occurred.
An allegation of abuse should not immediately be confirmed or dismissed until a thorough
assessment and investigation has been completed.