Non-accidental injury

Orthopaedic surgeons dealing with children in their practice are likely to be faced with the problem of non-accidental injury (NAI). Clues in the history may point to the possibility of child abuse. The range and radiographic appearances of skeletal injuries, some more specific to abuse than others, are discussed. Recognition of the classical metaphyseal lesion is paramount. Further investigation and differential diagnosis of NAI is considered, with emphasis on the use of follow-up radiographs in difficult cases. Imaging should be directed by experienced radiologists privy to all clinical information. Controversies surrounding the use of other imaging modalities are mentioned. A brief description of the legal issues and multidisciplinary approach to NAI is included. (C) 2007 Published by Elsevier Ltd.