A 9-month-old male infant is brought to the emergency department by his mother who reports that he has not been moving his right leg since yesterday. She says he "rolled off the couch." The father is not present. On examination, the infant is quiet and withdrawn. There is swelling of the right thigh. You notice multiple bruises of different ages on the trunk and arms. The right leg is painful with passive movement. There is a healing bruise on the right cheek.

$Skeletal survey images in a 9-month-old infant demonstrating multiple fractures at different healing stages consistent with non-accidental injury. The right femur shows an acute spiral fracture. There are healing posterior rib fractures bilaterally. A classic metaphyseal lesion (corner fracture) is visible at the distal tibia. The skull radiograph shows a parietal fracture. These multiple fractures at different stages of healing are highly suspicious for NAI.$

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Skeletal survey images in a 9-month-old infant demonstrating multiple fractures at different healing stages consistent with non-accidental injury. The right femur shows an acute spiral fracture. There are healing posterior rib fractures bilaterally. A classic metaphyseal lesion (corner fracture) is visible at the distal tibia. The skull radiograph shows a parietal fracture. These multiple fractures at different stages of healing are highly suspicious for NAI.

Source: Educational Paper: Imaging Child Abuse - The Bare Bones • PMC3258405 • CC-BY

What are the clinical red flags that suggest non-accidental injury?

Describe the skeletal survey findings and which fractures are highly specific for NAI.

What is the investigation protocol for suspected NAI?

What is the differential diagnosis and how do you exclude it?

What are the medicolegal and safeguarding responsibilities?

How do you determine the age of fractures?

Must Mention

•High-specificity: CML, posterior ribs, scapula, sternum
•Skeletal survey for all <2 years
•Repeat survey at 2 weeks
•Mandatory reporting requirement
•Ophthalmology for retinal hemorrhage
•OI is differential but doesn't exclude NAI

Common Pitfalls

•Missing mandatory reporting
•No repeat skeletal survey
•Wrong high-specificity fractures
•Missing ophthalmology
•Inappropriate documentation
•Excluding NAI due to OI

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Source: Educational Paper: Imaging Child Abuse - The Bare Bones • PMC3258405 • CC-BY

What are the clinical red flags that suggest non-accidental injury?

Describe the skeletal survey findings and which fractures are highly specific for NAI.

What is the investigation protocol for suspected NAI?

What is the differential diagnosis and how do you exclude it?

What are the medicolegal and safeguarding responsibilities?

How do you determine the age of fractures?

Must Mention

•High-specificity: CML, posterior ribs, scapula, sternum
•Skeletal survey for all <2 years
•Repeat survey at 2 weeks
•Mandatory reporting requirement
•Ophthalmology for retinal hemorrhage
•OI is differential but doesn't exclude NAI

Common Pitfalls

•Missing mandatory reporting
•No repeat skeletal survey
•Wrong high-specificity fractures
•Missing ophthalmology
•Inappropriate documentation
•Excluding NAI due to OI

Non-Accidental Injury (Child Abuse)

Questions

Must Mention

Common Pitfalls

Non-Accidental Injury (Child Abuse)

Questions

Must Mention

Common Pitfalls