Clinical Orthopaedics and Related Research®

, Volume 469, Issue 3, pp 790–797 | Cite as

Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

  • Ernest L. SinkEmail author
  • Joshua E. Hyman
  • Travis Matheny
  • Gaia Georgopoulos
  • Paul Kleinman
Symposium: Nonaccidental Trauma in Children



Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized.


In this review, we (1) define abuse, (2) describe the incidence and demographic characteristics of abuse, (3) describe the orthopaedic manifestations of abuse, and (4) define the orthopaedic surgeon’s role in cases of abuse.


We performed a PubMed literature review and a search of the Department of Health and Human Services Web site. The Pediatric Orthopaedic Surgery of North America trauma symposium was referenced and expanded to create this review.


Recognition and awareness of child abuse are the primary tasks of the orthopaedic surgeon. Skin trauma is more common than fractures, yet fractures are the most common radiographic finding. Patients with fractures who are younger than 3 years, particularly those younger than 1 year, should be evaluated for abuse. No fracture type or location is pathognomonic. Management in the majority of fracture cases resulting from abuse is nonoperative casting or splinting.


The role of the orthopaedic surgeon in suspected cases of child abuse includes (1) obtaining a good history and making a thorough physical examination; (2) obtaining the appropriate radiographs and notifying the appropriate services; and (3) participating in and communicating with a multidisciplinary team to manage the patients.


Physical Abuse Femur Fracture Osteogenesis Imperfecta Skull Fracture Oblique View 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Amy K. Monreal, BA, for technical assistance.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Ernest L. Sink
    • 1
    Email author
  • Joshua E. Hyman
    • 2
  • Travis Matheny
    • 3
  • Gaia Georgopoulos
    • 1
  • Paul Kleinman
    • 4
  1. 1.Department of Orthopaedic SurgeryUniversity of Colorado, The Children’s HospitalAuroraUSA
  2. 2.Department of Orthopaedic SurgeryColumbia University College of Physicians and Surgeons, Children’s Hospital of New YorkNew YorkUSA
  3. 3.Department of OrthopaedicsHarvard University, Children’s Hospital BostonBostonUSA
  4. 4.Department of RadiologyHarvard Medical SchoolBostonUSA

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