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A fracture indicates that substantial force has been applied to the head and is likely to have damaged the cranial contents.

Skull fractures may occur with no associated neurologic damage, and conversely, fatal injury to membranes, blood vessels, and brain may occur without overlying fracture.

Family physicians who suspect physical abuse are mandated to make a report to the state child protective services agency and to assure the ongoing safety of the child.

Physical abuse of children in our society is a serious problem that has only recently been recognized by the medical community.

A subdural hemorrhage in a child should be viewed with suspicion.

Most often, the subdural hemorrhages will demonstrate varying ages.

A shallow subdural space lies between the inner surface of the dura and the thin arachnoid mater that covers the surface of the brain. A skull fracture is a break in the skull bone and generally occurs as a result of direct impact.

Radiologists are often the first to suspect NAI when confronted with particular injury patterns, and a knowledge of these is essential if the opportunity to save a child from future neglect is not to be missed.In some cases, an historian may initially be considered reliable and later be considered to be unreliable.If you believe there are conditions that make the history and physical less reliable, use a low threshold for ordering radiological examinations.A typical skeletal survey comprises plain films of the following: The ability to date injuries is critical for medicolegal purposes, and thus must be done carefully (please refer to specialist text for specific guidelines). Metaphyseal (and costochondral junction) injuries do not heal with periosteal reaction and if visible are less than 4 weeks old.Traumatic periosteal injury can be seen up to 7 days post injury (and therefore can be used for dating). Skull fractures also do not heal with periosteal reaction and if seen are less than 2 weeks old.

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