Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 3/2011

01-03-2011 | Symposium: Nonaccidental Trauma in Children

Child Abuse and the Legal System: The Orthopaedic Surgeon’s Role in Diagnosis

Author: Christopher M. Sullivan, MD, MPH

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2011

Login to get access

Abstract

Background

Orthopaedic surgeons have unique training and experience in diagnosis of fractures, both accidental and nonaccidental. That experience is valuable in identifying physical child abuse and in avoiding false accusations or convictions. Both aspects are important to the welfare of children and their families. The events that follow a report of child abuse are outside the training and experience of most orthopaedic surgeons.

Questions/purposes

What process follows a report of suspected child abuse? What unexpected outcomes or results occur in this process? Are medical conclusions used in this process consistent with the state of our knowledge?

Methods

The child abuse legal process is described as experienced by one orthopaedic surgeon. Examples of unexpected problems that occurred in cases that went to trial are described.

Conclusions

Inappropriate outcomes can result from incomplete or incorrectly applied information. The input of the orthopaedic surgeon is often needed to provide the best information available to ensure that the best interests of the child and the family are protected. Working within a hospital team is the preferred method, but direct courtroom testimony is sometimes necessary.
Literature
2.
go back to reference Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 2003;54:1107–1110.CrossRefPubMed Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 2003;54:1107–1110.CrossRefPubMed
4.
go back to reference Binenbaum G, Mirza-George N, Christian CW, Forbes BJ. Odds of abuse with retinal hemorrhages in children suspected of child abuse. J AAPOS. 2009;13:268–272.CrossRefPubMed Binenbaum G, Mirza-George N, Christian CW, Forbes BJ. Odds of abuse with retinal hemorrhages in children suspected of child abuse. J AAPOS. 2009;13:268–272.CrossRefPubMed
5.
go back to reference Child Abuse Protection and Treatment Act (‘CAPTA’) (42 USC 5101 et seq; 42 USC 5116 et seq). Child Abuse Protection and Treatment Act (‘CAPTA’) (42 USC 5101 et seq; 42 USC 5116 et seq).
6.
go back to reference Dupuy v. McDonald, 141 F. Supp. 2d 1090, aff’d in relevant part at 397 F. 3d 493 (7th Cir 2005) discussing, inter alia, the consequences of having one’s name placed into the State Central Register and directing due process protections. Dupuy v. McDonald, 141 F. Supp. 2d 1090, aff’d in relevant part at 397 F. 3d 493 (7th Cir 2005) discussing, inter alia, the consequences of having one’s name placed into the State Central Register and directing due process protections.
7.
go back to reference Green NE, Swiontkowski MF. Skeletal Trauma in Children. Vol 3, 2nd ed. Philadelphia, PA: WB Saunders Co; 1998:588. Green NE, Swiontkowski MF. Skeletal Trauma in Children. Vol 3, 2nd ed. Philadelphia, PA: WB Saunders Co; 1998:588.
8.
go back to reference Hennrikus WL, Shaw BA, Gerardi JA. Injuries when children reportedly fall from a bed or couch. Clin Orthop Relat Res. 2003;407:148–151.CrossRefPubMed Hennrikus WL, Shaw BA, Gerardi JA. Injuries when children reportedly fall from a bed or couch. Clin Orthop Relat Res. 2003;407:148–151.CrossRefPubMed
9.
go back to reference Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J. Femoral fractures in children younger than three years old: the role of nonaccidental injury. J Pediatr Orthop. 2008;28:297–302.PubMed Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J. Femoral fractures in children younger than three years old: the role of nonaccidental injury. J Pediatr Orthop. 2008;28:297–302.PubMed
10.
go back to reference Illinois Abused and Neglected Child Reporting Act 325 ILCS 5/1 et seq. Illinois Abused and Neglected Child Reporting Act 325 ILCS 5/1 et seq.
11.
go back to reference Jayakumar P, Barry M, Ramachandran M. Orthopaedic aspects of paediatric non-accidental injury. J Bone Joint Surg Br. 2010;92:189–195.CrossRefPubMed Jayakumar P, Barry M, Ramachandran M. Orthopaedic aspects of paediatric non-accidental injury. J Bone Joint Surg Br. 2010;92:189–195.CrossRefPubMed
12.
go back to reference Keller KA, Barnes PD. Rickets vs abuse: a national and international epidemic. Pediatr Radiol. 2008;38:1210–1216.CrossRefPubMed Keller KA, Barnes PD. Rickets vs abuse: a national and international epidemic. Pediatr Radiol. 2008;38:1210–1216.CrossRefPubMed
13.
go back to reference Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, Datta S, Thomas DP, Silbert JR, Maguire S. Patterns of skeletal fractures in child abuse: systematic review. BMJ. 2008;337:a1518.CrossRefPubMed Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, Datta S, Thomas DP, Silbert JR, Maguire S. Patterns of skeletal fractures in child abuse: systematic review. BMJ. 2008;337:a1518.CrossRefPubMed
14.
go back to reference Paterson CR, McAllion SJ. Classical osteogenesis imperfecta and allegations of nonaccidental injury. Clin Orthop Relat Res. 2006;452:260–264.CrossRefPubMed Paterson CR, McAllion SJ. Classical osteogenesis imperfecta and allegations of nonaccidental injury. Clin Orthop Relat Res. 2006;452:260–264.CrossRefPubMed
15.
go back to reference Pressel DM. Evaluation of physical abuse in children. Am Fam Physician. 2000;61:3057–3064.PubMed Pressel DM. Evaluation of physical abuse in children. Am Fam Physician. 2000;61:3057–3064.PubMed
16.
go back to reference Santosky v. Kramer, 455 U.S. 745, 758–759, 71 L.Ed.2d 599,102 S.Ct. 1388 (1982). Supreme court commented on the array of resources against the individual parent. Santosky v. Kramer, 455 U.S. 745, 758–759, 71 L.Ed.2d 599,102 S.Ct. 1388 (1982). Supreme court commented on the array of resources against the individual parent.
17.
go back to reference Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta P 3rd. Accidental and non accidental femur fractures in children. Clin Orthop Relat Res. 2000;376:96–105.CrossRefPubMed Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta P 3rd. Accidental and non accidental femur fractures in children. Clin Orthop Relat Res. 2000;376:96–105.CrossRefPubMed
18.
Metadata
Title
Child Abuse and the Legal System: The Orthopaedic Surgeon’s Role in Diagnosis
Author
Christopher M. Sullivan, MD, MPH
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 3/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1564-5

Other articles of this Issue 3/2011

Clinical Orthopaedics and Related Research® 3/2011 Go to the issue