A skeletal survey is often diagnostic of the child abuse syndrome. The survey should include, at a minimum, two views of the skull, lateral view of the thoracolumbar spine, and anterior-posterior views of both upper extremities, hands, pelvis, and both lower extremities, including the feet. There are several radiologic signs suggestive of abuse. These include healing fractures, multiple fractures, fractures of unusual locations, and metaphyseal fractures. Other radiographic findings suggestive of abuse include posterior rib fractures, spinous process fractures, sternal fractures, complex skull fractures, and diaphyseal spiral and oblique fractures.
Fractures showing different stages of healing are almost pathognomonic of abuse.
Any fracture which already shows signs of healing suggests that the fracture is at least ten days old. Technetium 99 bone scanning has been shown to be highly sensitive when used to assess skeletal injury, particularly in occult areas not easily accessible to clinical exam. American law requires the reporting of any suspected abuse. A report of suspected abuse is a responsible attempt to protect a child. A significant number of children may be further abused if not protected and may even die from further injury.