Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Nonaccidental Trauma in Children 9 articles


Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

Ernest L. Sink MD, Joshua E. Hyman MD, Travis Matheny MD, Gaia Georgopoulos MD, Paul Kleinman MD

Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized.

Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review

Nirav K. Pandya MD, Keith Baldwin MD, MPH, MSPT, Atul F. Kamath MD, Dennis R. Wenger MD, Harish S. Hosalkar MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho)

Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN.

The Epidemiology of Nonaccidental Trauma in Children

Kishore Mulpuri MBBS, MS, MHSc, Bronwyn L. Slobogean PA-C, Stephen J. Tredwell MD, FRCSC

Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas.

Child Abuse and the Legal System: The Orthopaedic Surgeon’s Role in Diagnosis

Christopher M. Sullivan MD, MPH

Orthopaedic surgeons have unique training and experience in diagnosis of fractures, both accidental and nonaccidental. That experience is valuable in identifying physical child abuse and in avoiding false accusations or convictions. Both aspects are important to the welfare of children and their families. The events that follow a report of child abuse are outside the training and experience of most orthopaedic surgeons.

The Radiographic Approach to Child Abuse

Jerry R. Dwek MD

Osseous injuries are a major facet of child abuse and in most patients radiographic imaging plays a major role in diagnosis. While some injuries are typically produced as a result of excessive and inappropriate force other injuries are nonspecific in terms of their causation, but become suspicious when the history provided by the caretakers is inconsistent with the type of injury produced.

Femur Fractures in the Pediatric Population: Abuse or Accidental Trauma?

Keith Baldwin MD, MPH, MSPT, Nirav K. Pandya MD, Hayley Wolfgruber BA, Denis S. Drummond MD, Harish S. Hosalkar MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho)

Child abuse represents a serious threat to the health and well-being of the pediatric population. Orthopaedic specialists will often become involved when child abuse is suspected as a result of the presence of bony injury. Distinguishing abuse from accidental trauma can be difficult and is often based on clinical suspicion.