Dating Fractures

• Loss of fracture line definition — 10 to 21 days.

• Remodeling — 3 months to 2 years. For further information, see ref. 31.

Detecting occult injury is particularly important in the younger child and infant and recommended indications for a skeletal survey include the following (17,25,28,32):

• Any child younger than 2 years when there is a suspicion of physical abuse.

• Any child younger than 2 years presenting with a fracture suggestive of abuse.

• Consider in children aged 2-4 years with severe bruising.

• Older children with severe injuries.

• Children dying in unusual or suspicious circumstances.

• Physical abuse in an infant twin (or multiple birth sets) younger than 1 year— consider skeletal survey of the other infant(s) (33).

• Repeat views, particularly of ribs, may be useful 2 weeks after the initial survey, because periosteal reaction may not have formed around acute injuries.

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