'The roentgen manifestations of unrecognized skeletal trauma in infants'--a commentary.

摘要

This passage appears in the introduction of Frederic N. Silverman's classic article detailing the radiographic findings in infantswith "unrecognized skeletal trauma." His report appeared 8 years after John Caffey's groundbreaking AJR article describing infantile subdural hematoma and long-bone fractures. Like his mentor, Caffey, Silvermanwas trained in clinical pediatrics and then turned his interests to diagnostic radiology, first as a special assistant and then as junior associate to Caffey. He had been working with Caffey for just 9 months, a time he described as a "glorious gestational period," when the Caffey article was published. The cases described in Silverman's 1953 article were first shared with Caffey to be certain that the master agreed with his protegee . The Silverman article described the clinical, laboratory, and radiographic findings in three infants (age range, 2-7 months). Thematically, these cases were grouped not because of any explicit indication that the infants were abused but because their skeletal trauma was "unrecognized." In a relatively lengthy manuscript, Silverman artfully described in painful detail how the skeletal injuries in these three infants were unrecognized despite multiple interactions with health care providers. In contrast to the non-specific long-bone shaft injuries emphasized by Caffey , Silverman described and illustrated the two most important and specific injuries highly associated with infant abuse.