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Old 03-04-2013
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Question Child abuse or accidental injury?

A 14 month-old child is brought by her concerned father to the Emergency department with a history that the child slipped out and fell on the ground from a table that is 10 feet in height. He says the accident occurred last night when he let the child stand on the table. The child cries when the right thigh is touched and does not move the right lower extremity. Rest of the physical examination is normal. There are no suspicious bruises or contusions on the skin. An x-ray of the right femur is shown below.

Child abuse or accidental injury?-child-abuse-xray.jpg
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A skeletal survey is obtained and does not show any other fractures. There are no skull fractures or retinal hemorrhages or neurological deficits.

Based on the x-ray findings and the history, which of the following is the most likely diagnosis?

A) Osteogenesis Imperfecta
B) Fibrous Dysplasia
C) Accidental Injury
D) Child Abuse
E) Pathological Fracture from Ewing Sarcoma
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Old 03-04-2013
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D) Child Abuse
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Old 03-04-2013
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d child abuse
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Old 03-23-2013
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Default why not Ewing's Sarcoma?

my answer is E: Pathological fracture from Ewing's sarcoma

The x ray shows typical onion skin appearance.
The patient is of appropriate age group: Pediatric
and there is no bruises or contusions on the skin, which would be present if there was a trauma big enough to cause fracture of the femur, which is a very hard bone to break.

Any inputs? Novobiocin?
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Old 03-23-2013
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E .......................... .
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Old 03-24-2013
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Quote:
Originally Posted by wertheworld11 View Post
my answer is E: Pathological fracture from Ewing's sarcoma

The x ray shows typical onion skin appearance.
The patient is of appropriate age group: Pediatric
and there is no bruises or contusions on the skin, which would be present if there was a trauma big enough to cause fracture of the femur, which is a very hard bone to break.

Any inputs? Novobiocin?
i think ewing's is most common in 10-20 yrs age group..and also present with fever, elevated ESR...that's the reason the answer might not be ewing's...
but my guess is why the answer would be child abuse where accidental injury would also be appropriate one here...any explanations...?

thanks
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Old 03-24-2013
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by the way what kind of table would be 10 feet in height?
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Old 03-24-2013
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Quote:
Originally Posted by stfidel View Post
A 14 month-old child is brought by her concerned father to the Emergency department with a history that the child slipped out and fell on the ground from a table that is 10 feet in height. He says the accident occurred last night when he let the child stand on the table. The child cries when the right thigh is touched and does not move the right lower extremity. Rest of the physical examination is normal. There are no suspicious bruises or contusions on the skin. An x-ray of the right femur is shown below.

Attachment 3068
click image to enlarge

A skeletal survey is obtained and does not show any other fractures. There are no skull fractures or retinal hemorrhages or neurological deficits.

Based on the x-ray findings and the history, which of the following is the most likely diagnosis?

A) Osteogenesis Imperfecta
B) Fibrous Dysplasia
C) Accidental Injury
D) Child Abuse
E) Pathological Fracture from Ewing Sarcoma

i guess it is callus formation on xray
and father is lying when saying it heppened last night
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