Question of the week # 280

280) A 2 year old child is brought by her mother to the emergency department because the child has not been ambulating since yesterday after he tripped over an object and fell. Physical examination reveals tenderness and swelling in left mid-thigh. Eyes are normal without any hemorrhages. Skin reveals several bruises. Teeth are translucent and show yellow discoloration. Moderate scoliosis is evident. A skeletal survey reveals rib fractures and multiple fractures in various stages of healing. There is diffuse osteopenia. There is a spiral fracture of left femur shaft.  The limb is splinted and an orthopedic consult is obtained. Which of the following is the most appropriate action?

A) Contact social services

B) Contact Child Protection Services

C) Place the child in foster care

D) Obtain Head CT

E) Obtain detailed family history

12 Responses

  1. b

  2. d

  3. d

  4. e

  5. E

  6. b

  7. D, Osteogenesis imperfecta o child abuse. the probability of intracraneal Hemorrhagia we have to rule out first.

  8. ddd

  9. ans : E

    This patient has high probability for ostegenesis imperfecta .

    Between Head CT and Obtained FH , i would go for FH .

    FH first and then you can decide to or not to do head CT . The guardians or parents are right in front of you . Obtaining a Family history only takes few minutes .

    Just my 2cents 🙂

  10. what is the answer Dr. Red? child abuse is very difficult ?
    like to go CT and ten CPS

  11. ~ E
    i would go with family hx first than CT head.

  12. E

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