DRK Kliniken Berlin | Westend, Department of Pediatrics, Child Protection Outpatient Clinic; DRK Kliniken Berlin | Westend, Department of Diagnostic and Interventional Radiology; DRK Kliniken Berlin | Westend, Department of Trauma Surgery and Orthopedics; Department of Child and Adolescent Psychiatry/Psychotherapy.
Dtsch Arztebl Int. 2018 Nov 16;115(46):769-775. doi: 10.3238/arztebl.2018.0769.
It is well known that physical abuse of children all too often escapes detection. Fractures are among the potential consequences of physical abuse but are also com- mon in childhood because of accidents. A question frequently addressed to the Medical Child Protection Hotline (Medizini- sche Kinderschutzhotline) is how fractures due to abuse can be distinguished from accidental fractures.
This review is based on pertinent publications retrieved by a search in PubMed and in the Cochrane Data- base, as well as on the authors' experience in a pediatric emergency department with ca. 29 000 consultations per year and in a child protection outpatient clinic with ca. 100 consultations per year.
Fractures due to abuse are especially common among infants; their incidence is estimated at 56.8/100 000 among infants less than six months old and 39.8/100 000 among infants aged 6 to 11 months. In consideration of the age of the child, the type of fracture, the history, and other factors, a high probability of abuse can be suspected in many cases, so that further measures can be initiated.
All physicians involved in the care of children (even if only occasionally) should be aware of the major indicators of likely physical abuse and of the available oppor- tunities for counseling and intervention. Failures to diagnose child abuse are associated with high rates of recurrence and mortality.
众所周知，儿童身体虐待往往难以被察觉。骨折是身体虐待的潜在后果之一，但在儿童时期也很常见，因为会发生意外。医疗儿童保护热线（Medizinische Kinderschutzhotline）经常会收到这样的咨询，即如何区分因虐待导致的骨折和意外导致的骨折。
本综述基于在 PubMed 和 Cochrane 数据库中检索到的相关出版物，以及作者在儿科急诊部（每年约有 29000 次就诊）和儿童保护门诊（每年约有 100 次就诊）的经验。
虐待导致的骨折在婴儿中尤为常见；6 个月以下婴儿的发病率估计为每 10 万人中有 56.8 例，6 至 11 个月婴儿的发病率为每 10 万人中有 39.8 例。考虑到儿童的年龄、骨折类型、病史和其他因素，在许多情况下，都高度怀疑存在虐待行为，从而可以采取进一步的措施。
所有参与儿童护理的医生（即使只是偶尔）都应该了解可能存在身体虐待的主要指标，以及咨询和干预的机会。未能诊断儿童虐待与高复发率和死亡率有关。
