Citation

Goldner D, Vittorio J, Barrios DM, McGuire J, Brodlie S, Brown J, Lobritto S, Martinez M. Pediatr. Emerg. Care 2019; ePub(ePub): ePub.

Affiliation

Department of Social Work, New York Presbyterian Hospital, New York, NY.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/PEC.0000000000001740

PMID

30672906

Abstract

Certain fractures in children are highly specific for child abuse. Metabolic bone disease frequently develops in patients with cholestatic liver disease (CLD); this can result in weakened bones and a predisposition to pathologic fractures. Fractures that occur in patients with rickets and osteopenia may mimic a bone response to inflicted injury, which in children raise the concern of child abuse. Here we report a series of 15 patients with CLD who developed pathologic fractures in the setting of metabolic bone disease. During initial evaluation, the caretakers of 5 of these 15 patients were reported to child protective services and investigated for child abuse. Pediatricians should be aware that children with CLD have an increased incidence of pathologic fractures, even after the cholestasis has resolved.

Language: en