title: The presence of bruising associated with fractures.
abstract: OBJECTIVE
  To determine the occurrence of bruising near the site of fracture in a group of children with inflicted fractures.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Two children's hospitals.
  
  
  METHODS
  Suspected child abuse victims with fractures.
  
  
  METHODS
  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.
authors.affiliation: Pediatric Emergency Medicine, The Children's Hospital of Alabama, 1600 6th Ave S, Midtown Bldg, Ste 205, Birmingham, AL 35233, USA. mpeters@peds.uab.edu
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Peters
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Starling
authors.forename: Myra L
authors.initials: ML
authors.lastname: Barnes-Eley
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Heisler