Objective: To determine the occurrence of bruising near the site of fracture in a group of children with inflicted fractures.
Design: Case series.
Setting: Two children's hospitals.
Participants: Suspected child abuse victims with fractures.
Main outcome measure: The presence of bruising and fracture in a single body region or appendage.
Results: The study included 192 children with inflicted fractures. No bruising was found in 111 (57.8%) of the study participants. Forty patients (20.8%) had bruising near the site of at least 1 fracture. Of these, bruising or subgaleal hematoma near the site of a skull fracture was seen most often, in 43.3% of patients. Bruising in association with extremity fractures was seen much less commonly, ranging from 3.8% (n = 2) of children with tibia fracture to 16.7% (n = 1) of children with fibula fracture. Rib fractures also were associated uncommonly with bruising. When skull fractures are excluded, 45 (8.1%) of 555 fractures had bruising near the fracture site, in 13 (6.8%) patients.
Conclusions: In children with inflicted skeletal trauma, the fractured bones that most frequently have associated bruising are the skull bones. The presence of bruising near the fracture site is uncommon in extremity or rib fractures.