Abuso Infantil: El Papel del cirujano ortopédico en trauma no accidental / Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

  • Posted by victor valdes
  • Posted on diciembre 17, 2014
  • Uncategorized
  • Comentarios desactivados en Abuso Infantil: El Papel del cirujano ortopédico en trauma no accidental / Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032840/

Abstract

Background

Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized.

Questions/purposes

In this review, we (1) define abuse, (2) describe the incidence and demographic characteristics of abuse, (3) describe the orthopaedic manifestations of abuse, and (4) define the orthopaedic surgeon’s role in cases of abuse.

Methods

We performed a PubMed literature review and a search of the Department of Health and Human Services Web site. The Pediatric Orthopaedic Surgery of North America trauma symposium was referenced and expanded to create this review.

Results

Recognition and awareness of child abuse are the primary tasks of the orthopaedic surgeon. Skin trauma is more common than fractures, yet fractures are the most common radiographic finding. Patients with fractures who are younger than 3 years, particularly those younger than 1 year, should be evaluated for abuse. No fracture type or location is pathognomonic. Management in the majority of fracture cases resulting from abuse is nonoperative casting or splinting.

Conclusions

Clin Orthop Relat Res. Mar 2011; 469(3): 790–797.
Published online Oct 13, 2010. doi:  10.1007/s11999-010-1610-3
PMCID: PMC3032840

Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

Abstract

Background

Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized.

Questions/purposes

In this review, we (1) define abuse, (2) describe the incidence and demographic characteristics of abuse, (3) describe the orthopaedic manifestations of abuse, and (4) define the orthopaedic surgeon’s role in cases of abuse.

Methods

We performed a PubMed literature review and a search of the Department of Health and Human Services Web site. The Pediatric Orthopaedic Surgery of North America trauma symposium was referenced and expanded to create this review.

Results

Recognition and awareness of child abuse are the primary tasks of the orthopaedic surgeon. Skin trauma is more common than fractures, yet fractures are the most common radiographic finding. Patients with fractures who are younger than 3 years, particularly those younger than 1 year, should be evaluated for abuse. No fracture type or location is pathognomonic. Management in the majority of fracture cases resulting from abuse is nonoperative casting or splinting.

Conclusions

The role of the orthopaedic surgeon in suspected cases of child abuse includes (1) obtaining a good history and making a thorough physical examination; (2) obtaining the appropriate radiographs and notifying the appropriate services; and (3) participating in and communicating with a multidisciplinary team to manage the patients.

Resumen
Entorno

El maltrato infantil se presenta en muchas formas diferentes: física, sexual, psicológica, y el abandono. El cirujano ortopédico está involucrado en su mayoría con el abuso físico, pero debe ser consciente de las otras formas. Hay una formación limitada en cuanto al abuso de menores, y la documentación es deficiente cuando un paciente está en riesgo de abuso. Existe un riesgo considerable a los niños cuando no se reconoce el abuso.

Preguntas / fines

En esta revisión, (1) define el abuso, (2) describir la incidencia y las características demográficas de abuso, (3) Describir las manifestaciones ortopédicas de abuso, y (4)definir el papel del cirujano ortopédico en casos de abuso.

Resultados

El reconocimiento y la conciencia del abuso infantil son las tareas principales del cirujano ortopédico. El trauma de la piel es más común que las fracturas, pero las fracturas son el hallazgo radiológico más común. Los pacientes con fracturas, que son menores de 3 años, en particular los menores de 1 año, deben ser evaluados para el abuso. Ningún tipo de fractura o ubicación es patognomónico. La gestión en la mayoría de los casos de fractura como resultado de abuso es no quirúrgico yeso o ferula.

Conclusiones

El papel del cirujano ortopédico en los presuntos casos de maltrato infantil incluye: (1) obtener una buena historia y hacer un examen físico completo; (2) la obtención de lasradiografías apropiadas y notificar a los servicios apropiados; y (3) la participación y la comunicación con un equipo multidisciplinario para atender a los pacientes.

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