In the above examples the initial radiograph demonstrates an old humeral fracture with periostial reaction. On closer inspection, further fractures are evident - see next thumbnail where periostial reaction is seen affecting the little finger metacarpal. Also, a distal radial corner fracture and a subtle distal ulnar fracture are present. The radiograph of the left lower limb demonstrates multiple metaphyseal corner fractures and bucket handle fractures (the same sort of fracture viewed in a different plane). An example of each has been magnified, if you didn't seen the fractures on the previous radiograph of the wrist, go back and look now that you have seen the metaphyseal corner fracture highlighted here. Finally, subtle rib fractures are present.

The following types of fracture should alert you to the possibilty of non-accidental injury:

  • Posterior rib fractures
  • Fractures of differing ages
  • Metaphyseal corner fractures and bucket handle fractures
  • Spiral long bone fractures before walking
  • Fractures of scapula, spinous process and sternum
  • Acute or chronic subdural haematoma
  • Duodenal haematoma (can occur after endoscopy), pancreatitis, lung contusion