Skeletal Injuries

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.