It is important to remember that all of the skeletal injuries associated with accidental trauma can also be inflicted as a result of nonaccidental injury (e.g., child battering, shaken baby syndrome, or child abuse). However, certain injury patterns are encountered consistently as a result of child maltreatment, particularly multiple fractures in various stages of healing. An understanding of the various mechanisms of inflicted injury will facilitate better awareness of the patterns of injury suggesting abuse. Correlation of the child's age, motor capabilities, and the alleged mechanism of injury with the injury pattern being evaluated is fundamental to the evaluation of childhood skeletal injuries, as is the identification of coexisting cutaneous signs suggestive of abuse (e.g., suspicious bruises, burns, etc.).
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