Evidence brief
Non-Accidental Injury: Skeletal Manifestations
Classic metaphyseal lesions (bucket handle/corner fractures)
Multiple fractures of different ages
Rib fractures in infants highly suspicious
Femur fractures in non-walking children
Skeletal survey protocols standardized
Recognition of skeletal patterns suspicious for NAI is essential for child safeguarding. Orthopaedic surgeons have mandatory reporting obligations.
High specificity findings: classic metaphyseal lesions, rib fractures (especially posterior), scapular/spinous process fractures, multiple fractures different healing stages. Differential: OI, metabolic bone disease. Know your hospital's safeguarding pathway. Skeletal survey indications.
Kleinman PK. Diagnostic Imaging of Child Abuse. 2nd ed. St. Louis: Mosby; 1998.
Level V
Expert opinion or mechanism-based reasoning