The objective of this paper is to review common challenges when evaluating fractures in the setting of possible child abuse and approaches to navigate them. This paper reviews the variety of imaging modalities available for evaluating child abuse and the advantages/disadvantages of each. Additionally, the authors discuss management of equivocal fractures, including the impact of double-reading skeletal surveys. The complexity of dating the acuity of fractures in young children is discussed. Utilizing the knowledge of fracture type, fracture patterns and patient history, as well as in the setting of cardiopulmonary resuscitation, the authors provide methods for determining the likelihood of abuse.
Keywords: Child abuse; Classic metaphyseal lesion; Computed tomography; Fracture; Infants; Magnetic resonance imaging; Non-accidental trauma; Skeletal survey; Ultrasonography.