Multiple metatarsal fractures in child abuse

Ever since Caffey's classic description of its clinical findings, physicians have been aware of the syndrome of child abuse and its skeletal pathology. Because of the emphasis placed on them by Caffey and others, it is now considered standard medical practice to obtain roentgenograms of the skull, ribs, and long bones as part of the routine evaluation of suspected child abuse. The authors are reporting an abused infant with multiple metatarsal fractures, an apparently undescribed finding in maltreatment syndromes. The authors also raise the question of whether or not roentgenographic search for fractures of the small bones of the extremities should be routinely performed.