1. NON ACCIDENTAL INJURIES

2. INTRODUCTION
 Commonly known as “ BATTEREDCHILD
SYNDROME .“
 CAFFEY – introduced the term “whiplash
shaken infant syndrome.”
 Spectrum of injuries associated with child
abuse varying from bruises to burns.

3. RISK FACTORS
 Child :
o Younger age (< 3yrs)
o Low socio economic status
o 1 st born
o Step child
o Unplanned / premature births
o Multiple births
o Special needs – eg: handicapped
 Abuser :
o Younger age

4. o Single
o Drugs
o Parents with h/o abuse
o Unemployed

5. History & physical
examination
 Critical in the diagnosis of non accidental
injuries.
 When NAI is suspected thorough history 
regarding mechanism & duration of injury.
 o/e –
 soft tissue injuries : most common  bruises,
welts, abrasions, lacerations, scars, cigarette
burns, bite marks.

6.  Fractures : suspicious fracture patterns 
metaphyseal corner #, lower extremity # in non
ambulatory children, b/l acute #, rib & spine #,
physeal # in young children.
Metaphyseal bucket handle or corner # -
pathognomonic in abusive trauma.
Skull # are difficult to diagnose.
Complex skull & rib # in children younger than 2 yrs.
posterior rib # -- front-to-back chest compression…
Rib # can occur anywhere along the arc.

7. Acute anterior costo chondral seperations can occur,
difficult to diagnose with x-rays  usg.
Severe lung contusions, necklace calcifications…
Spinal # : rare, occcurs whe a child is forcibly
slammed on to a flat surface – hyperflexion injury.

8.  Neurological injuries : leading cause of death.
 Burns : usually in accidental burns – arrow head
configuration, splash marks. Abuse – well
demarcated 2nd or 3rd degree burns with
circumferential definition.
 Abdominal injuries : blunt trauma
 Genital injuries

9. Additional imaging studies
 Skeletal surveys : in all cases of suspected
abuse in children <2 yrs.
Includes AP & lateral views of skull, spine; AP of
chest, shoulders, pelvis, extremities, feet and
hands. Oblique x-rays of hand…
Baby-gram not adequate.
 Technetium bone scans
 Sonograms

10. Interpreting images in child
abuse
X- ray # patterns in abuse  not characteristic.
Spiral # of humerus; tibia, femur…mid shaft or
distal fractures.
Multiple #, exuberant callus..
Juxtacortical calcification without fractures.
The key is to maintain a high level of suspicion

11. Specificity for skeletal trauma
in abuse
High specificity
Any metaphyseal lesion
Posterior rib #
Scapular #
Spinous process #
Sternal #
Moderate specifity
Multiple # espcially b/l
# of different ages
Epiphyseal seperation
Vertebral body # or subluxation
Digital #
Complex skull #
Low specificity
Clavicular #
Long bone shaft #
Linear skull #

12. DATING FRACTURES
X-RAY
APPEARANCE
PEAK CHANGES
Resolution of soft tissue
swelling
New periosteal bone
Loss of definition of # line
Presence of soft callus
Presence of hard callus
Remodelling of #
4 – 10 days
10 -14 days
14 – 21 days
14 – 21 days
21 – 42 days
1 year (early – 3 months to
2yrs for maturity )

13. LAB INVESTIGATIONS
 CBC, ESR, LFT, URINALYSIS
 CLOTTING STUDIES
 TOXICOLOGY SCREEN
 EVALUATION FOR NON ORTHOPAEDIC
INJURIES

14. Thank you