(iv) Imaging of non-accidental injury

Child abuse (including physical injury, emotional abuse, sexual abuse and neglect) is a social problem that is increasingly recognized not only by health care professionals but also by the government and public. Non-accidental injury (NAI) is defined as injury of a child resulting from an abusive act by a carer. All clinicians treating children including orthopaedic surgeons should be able to recognize common presentations of NAI, identify typical fractures resulting from abuse and initiate child protection investigations to prevent further injury to the child. This article focuses on non-accidental skeletal injury. It explains the importance of a detailed skeletal survey that should be performed to agreed standards by trained radiographers and reported by a radiologist with experience in paediatric trauma imaging. Typical fractures are illustrated and important differential diagnoses are discussed.