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Orthopedic manifestations of child abuse


Child abuse is common in the United States but is often undetected. The incidence of this form of abuse is difficult to quantify, but children with a history of abuse are at risk of chronic health conditions. Medical providers are in the unique position of triaging trauma patients and differentiating unintentional from abusive trauma, as well as having the important position of being a mandated reporter of abuse in all states. Obtaining a detailed history and screening for risk factors can help identify children at risk of abuse. Certain orthopedic injuries may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through medical provider education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. This review evaluates current literature regarding the orthopedic manifestations of child abuse in hopes of increasing medical provider awareness.


  • Child abuse is common in the United States but often remains undetected.

  • Medical professionals are in the unique position of evaluating trauma patients and identifying concerns for abusive injuries.

  • Certain orthopedic injuries may raise concern for abuse triggering clinical suspicion and further workup or intervention.

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Fig. 1: AP pelvis, AP left shoulder, AP/lateral right wrist, and AP right tibia.
Fig. 2: AP chest.
Fig. 3: AP femur.


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Correspondence to John D. Milner.

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Milner, J.D., Hartnett, D.A., DeFroda, S.F. et al. Orthopedic manifestations of child abuse. Pediatr Res (2021).

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