Multiple fractures in infancy: scurvy or nonaccidental injury?

Abstract

Colin R PatersonFormerly of Department of Medicine, University of Dundee, Dundee, Scotland, UKAbstract: The child with unexplained fractures has a differential diagnosis that includes nonaccidental injury but also a number of bone disorders including osteogenesis imperfecta and rickets. This paper reports a 14-month-old girl who was found to have seven fractures, several hematomas and widespread sub-periosteal reactions. She was found to have biochemical evidence of vitamin C deficiency. While nonaccidental injury could not be excluded, it seemed likely that the major cause of the fractures was scurvy. It is important to consider the whole differential diagnosis in a child with unexplained fractures.Keywords: scurvy, vitamin C deficiency, nonaccidental injury, fractures, ascorbic acid