Neonatal skeletal fractures. Birth trauma or child abuse?

When a fracture is discovered in a newborn infant, it is important to decide whether it occurred at birth or after birth. Calcification around the fracture site gives a useful estimate of the age of the fracture. We reviewed films of 23 patients with fractures resulting from delivery. The fractures occurred at three different sites: the clavicle, the humerus, and the femur. Calcification could be seen as early as seven days after birth and was absent for as long as 11 days after birth. Six of seven femoral fractures occurred in infants with neuromuscular problems. Fracture at an unusual site or absence of calcification after 11 days should alert the radiologist to the possibility of abuse.