Differential Diagnosis of Skeletal Injury

• Accidental injury—appropriate, consistent history, and prompt presentation.

• Normal variation—skull suture, physiological periosteal reaction (symmetric and smooth around the long bones of children from 6 weeks to 6 months).

• Birth trauma—commonly clavicle or humerus.

• Infection—osteomyelitis or congenital syphilis.

• Rickets—nutritional, renal, chronic illness, and prematurity.

• Cancers—neuroblastoma or leukemia.

• Osteogenisis imperfecta—a rare condition, incidence of 1 in 20,000, usually accompanied by a family history of fractures, fractures with minimal trauma, easy bruising, joint laxity, early-onset deafness, blue sclerae, and dentinogenesis.

• Copper deficiency—low-birth-weight preterm infants, malnutrition, or malabsorption.

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