title: Skeletal injuries associated with sexual abuse.
abstract: BACKGROUND
  Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act.
  
  
  OBJECTIVE
  To describe concurrent sexual abuse and fractures.
  
  
  METHODS
  Three children with pelvic or femoral shaft injuries in association with sexual abuse.
  
  
  RESULTS
  A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis.
  
  
  CONCLUSIONS
  Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected.
authors.affiliation: Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. karl.johnson@bch.nhs.uk
authors.forename: Karl
authors.initials: K
authors.lastname: Johnson
authors.forename: Stephen
authors.initials: S
authors.lastname: Chapman
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hall
mesh_terms: D002650:Child Abuse, Sexual; D002675:Child, Preschool; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D007223:Infant; D010502:Perineum / Q000000981:diagnostic imaging / Q000293:injuries; D011630:Pubic Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging / Q000209:etiology