Fractures in early childhood: osteogenesis imperfecta or child abuse?

We studied the radiographs of 194 fractures sustained by 39 children less than 5 years of age with osteogenesis imperfecta (OI) and compared them with radiographs of 84 fractures sustained by 69 normal children of the same age. A great variety of fracture patterns was observed in undoubted OI. Spiral and transverse fractures were the most common. Metaphyseal fractures accounted for 15% of the fractures. The results of this study do not support the view that a particular fracture pattern renders the diagnosis of OI unlikely.