Skeletal Survey

Confessed abuse or high suspicion for abuse
Injury during Domestic Violence
Fracture due to impact from toy or other object
Delayed presentation >24 hours for a child in obvious distress
Fracture accompanied by unrelated injury signs (e.g. Bruises, burns)
Fracture not explained by Trauma History EXCEPT in ambulatory child >9 months AND
1. Distal radius/ulna buckle Fracture (esp. if Fall on Outstretched Hand) OR
2. Distal tibia/fibula spiral or buckle Fracture (esp. if fall while Running or walking)
All children <12 months old with ANY Fracture EXCEPT no additional concerns AND
1. Linear, unilateral Skull Fracture in child >6 months and significant fall (e.g. height >3 feet)
2. Clavicle Fracture attributable to Birth Trauma
  1. Acute Clavicle Fracture in child age <22 days old
  2. Healing Clavicle Fracture in child age <30 days old
All children 12-23 months old with any of the following Fractures
1. Rib Fracture
2. Classic methaphyseal Fracture
3. Ping-pong or other complex Skull Fracture
4. Humerus Fracture due to a short fall (<3 feet) with epiphyseal separation
5. Femur Fracture through diaphysis due to fall from any height

Anteroposterior (AP) Xrays of bilateral Humerus, Forearm, hands
Anteroposterior (AP) Xrays of bilateral femurs, tib-fib, feet
Anteroposterior (AP) Xrays of Pelvis (catches mid-Lumbar Spine)
Cervical Spine lateral xray
Lumbosacral Spine lateral xray
Thoracic Spine (lateral as well as AP and obliques to evaluate for Rib Fractures)
Skull lateral and frontal xray