{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:51:29Z","timestamp":1787021489744,"version":"build-2736575974"},"reference-count":68,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"2","license":[{"start":{"date-parts":[[2010,2,1]],"date-time":"2010-02-01T00:00:00Z","timestamp":1264982400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2010,2]]},"abstract":"<jats:p>Non-accidental injury (NAI) in children includes orthopaedic trauma throughout the skeleton. Fractures with soft-tissue injuries constitute the majority of manifestations of physical abuse in children. Fracture and injury patterns vary with age and development, and NAI is intrinsically related to the mobility of the child. No fracture in isolation is pathognomonic of NAI, but specific abuse-related injuries include multiple fractures, particularly at various stages of healing, metaphyseal corner and bucket-handle fractures and fractures of ribs. Isolated or multiple rib fractures, irrespective of location, have the highest specificity for NAI. Other fractures with a high specificity for abuse include those of the scapula, lateral end of the clavicle, vertebrae and complex skull fractures.<\/jats:p>\n                  <jats:p>Injuries caused by NAI constitute a relatively small proportion of childhood fractures. They may be associated with significant physical and psychological morbidity, with wide- ranging effects from deviations in normal developmental progression to death.<\/jats:p>\n                  <jats:p>Orthopaedic surgeons must systematically assess, recognise and act on the indicators for NAI in conjunction with the paediatric multidisciplinary team.<\/jats:p>","DOI":"10.1302\/0301-620x.92b2.22923","type":"journal-article","created":{"date-parts":[[2010,2,3]],"date-time":"2010-02-03T22:05:19Z","timestamp":1265234719000},"page":"189-195","source":"Crossref","is-referenced-by-count":51,"title":["Orthopaedic aspects of paediatric non-accidental injury"],"prefix":"10.1302","volume":"92-B","author":[{"given":"P.","family":"Jayakumar","sequence":"first","affiliation":[{"name":"The Royal London Hospital, Whitechapel Road, Whitechapel, London E1 1BB, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Barry","sequence":"additional","affiliation":[{"name":"The Royal London Hospital, Whitechapel Road, Whitechapel, London E1 1BB, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"The Royal London Hospital, Whitechapel Road, Whitechapel, London E1 1BB, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Caffey J.\n                      Multiple fractures in the long bones of infants suffering from chronic sub-dural haematoma. Am J Roentgenol 1946;56:163."},{"key":"R2","doi-asserted-by":"crossref","unstructured":"McMahon P, Grossman W, Gaffney M, Stanitski C.\n                      Soft-tissue injury as an indication of child abuse. J Bone Joint Surg [Am] 1995;77-A:1179\u201383.","DOI":"10.2106\/00004623-199508000-00006"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200001000-00002"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2008.04.002"},{"key":"R5","doi-asserted-by":"crossref","unstructured":"Carty H, Pierce A.\n                      Non-accidental injury: a retrospective analysis of a large cohort. Eur Radiol 2002;12:2919\u201325.","DOI":"10.1007\/s00330-002-1436-9"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.146.2.6849085"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2001.21345"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcfm.2005.08.001"},{"key":"R9","unstructured":"Fong CM, Cheung HM, Lau PY.\n                      Fractures associated with non-accidental injury: an orthopaedic perspective in a local regional hospital. Hong Kong Med J 2005;11:445\u201351."},{"key":"R10","unstructured":"Christian CW.\n                      Etiology and prevention of abuse: family and individual factors. In: Lud-wig S, Kornberg AE, eds.\n                      Child abuse: a medical reference\n                      . Churchill-Livingstone, 1992:39\u201347."},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpb.0000271328.79481.07"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1518"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1754.2000.00592.x"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.293.6539.100"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1993.02160250089028"},{"key":"R16","doi-asserted-by":"crossref","unstructured":"Schwend RM, Werth C, Johnston A.\n                      Femur shaft fractures in toddlers and young children: rarely from child abuse. J Pediatr Orthop 2000;20:475\u201381.","DOI":"10.1097\/01241398-200007000-00010"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1007\/s003300050303"},{"key":"R18","unstructured":"No authors listed.\n                      Department of Health. Working together to safeguard children. London: The Stationery Office, 2006. http:\/\/www.everychildmatters.gov.uk\/files\/AE53C8F9D7AEB1B2E403514A6C1B17D.pdf (date last accessed 21 September 2009)."},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(46)80122-7"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.106120"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198801000-00010"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.044065"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpem.2006.06.007"},{"key":"R24","doi-asserted-by":"crossref","unstructured":"Taitz LS.\n                      Child abuse and metabolic bone disease: are they often confused? 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In: Kasser JR, Beaty JB, eds.\n                      Rockwood and Wilkins fractures in children\n                      . Sixth edition. Philadelphia: Lippincott-Raven, 1996."},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.01.036"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.75B6.8245070"},{"key":"R33","unstructured":"King J, Diefendorf D, Apthorp J, Negrette VF, Carlson M.\n                      Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 1988;8:585\u20139."},{"key":"R34","unstructured":"No authors listed.\n                      Welsh Child Protection Systematic Review Group. Is this fracture due to abuse? a systematic review of fractures in child abuse. 2005. http:\/\/www.core-info.cf.ac.uk (date last accessed 22 September 2009)."},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.150.3.635"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000068992.01030.A8"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2005.12.007"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1007\/BF01371340"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70137-3"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.1.173"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.1136\/adc.59.3.246"},{"key":"R42","doi-asserted-by":"crossref","unstructured":"Billmire ME, Myers PA.\n                      Serious head injury in infants: accident or abuse? 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J Bone Joint Surg [Am] 1995;77-A:1471\u20136.","DOI":"10.2106\/00004623-199510000-00001"},{"key":"R55","doi-asserted-by":"crossref","unstructured":"Shapiro F, Holtrop ME, Glimcher MJ.\n                      Organization and cellular biology of the perichondral ossification groove of ranvier: a morphological study in rabbits. J Bone Joint Surg [Am] 1977;59-A:703\u201323.","DOI":"10.2106\/00004623-197759060-00001"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.167.6.8956566"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.156.4.2003446"},{"key":"R58","doi-asserted-by":"publisher","DOI":"10.1159\/000121475"},{"key":"R59","unstructured":"No authors listed.\n                      Child Protection Companion. April 2006. 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