Non-accidental fractures in child maltreatment syndrome

Non-accidental fractures are the second most common injuries in maltreated children presenting to the emergency department. It is estimated that 30% of maltreated children evaluated have either acute or healing fractures. The hallmarks of these injuries are multiple fractures at different stages of healing. However, certain isolated fracture patterns are also observed. The determination of the non-accidental nature of injury remains a challenge, and a delay in diagnosis may place the child at increased risk of sustaining further injuries or death. In this article we will review the historical and physical characteristics, common fractures, and radiographic findings of non-accidental fractures in maltreated children. Careful evaluation of historical data, identification of children at high risk for maltreatment, accurate interpretation of radiographs, and a timely referral to social services may result in reduced morbidity and mortality.