Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For diagnosing suspected fractures in children, the primary imaging modality is X-rays NICE CKS,NICE CKS,NICE CKS. There should be a low threshold for same-day X-rays to detect fractures or evidence of bone disease in children, particularly those presenting with an acute limp following trauma NICE CKS,NICE CKS,NICE CKS. This is because a sprain in a child should be considered a possible growth plate injury, as growth plates are more vulnerable to injury than ligaments NICE CKS,NICE CKS,NICE CKS.
In specific circumstances, other imaging modalities are appropriate:
- For children under 16 with a head injury and suspected cervical spine injury, a CT cervical spine scan is indicated if certain risk factors are present, such as a GCS score of 12 or less, intubation, or strong clinical suspicion despite normal X-rays NICE NG232. If there is neck pain or tenderness but no indications for a CT scan, 3-view cervical spine X-rays may be performed based on specific risk factors like a dangerous mechanism of injury or inability to assess neck movement NICE NG232. Plain X-rays of the skull should not be used to diagnose important traumatic brain injury NICE NG232.
- For children under 16 with suspected non-accidental injury, a skeletal survey may be necessary NICE NG232. X-ray evidence of occult fractures, such as rib fractures in infants, can raise suspicion of child maltreatment NICE CG89.