Pediatric bone fractures: challenges in differential diagnosis between child abuse and osteogenesis imperfecta

Bone fractures are referred as a common condition in childhood. Despite that, the clinical approach to pediatric patients with bone fractures is still considered complex, especially because of the anatomical, biomechanical, and physiological differences in bone composition during childhood and adolescence. In the clinical-diagnostic algorithm of patients with non-traumatic bone fractures, a clear anamnestic evaluation and a careful clinical and radiological analysis are essential to suspect rare conditions, such as osteogenesis imperfecta (OI), or to intercept frequent alarm conditions related to child abuse. OI is a rare connective tissue disorder characterized by increased bone fragility and decreased bone mass, leading to frequent fractures. Bone fractures in patients with OI differ according to the type of genetic mutation, age, site of location, and recurrence of fractures. In child abuse, a public health concern worldwide, fractures are considered the second most common injury after skin injuries. The number of fractures, site of location, anamnestic and radiological evaluation, and additional specific signs must be sought to suspect a condition of child abuse. The purpose of this review is to address the complexities of the differential diagnosis of bone fractures caused by childhood abuse and OI.