Slide 117 — Non-accidental injury

Type / group	Definition / note
Ix	skeletal survey +/- bone scan in <5, take bloods, rule out metabolic bone disease or OI

Q1 What are the radiographic findings for Non-accidental injury?

•Left sided Xray shows a corner fracture of the distal femur

•Right sided Xray shows a bucket handle fracture of the proximal tibia

•(bucket handle = corner #, just looking from different view)

•Both in a skeletally immature patient are very suggestive of non accidental injury (NAI)

Q2 What signs or features are listed for Non-accidental injury?

Multiple bruises (Most common symptom is skin lesion)

•Multiple fractures in various stages of healing

•Long bone fxs in infant that is not yet walking

•Metaphyseal Fractures

•1. Corner fxs (primary spongiosa)

•2. Bucket handle

•Transphyseal separation of the distal humerus

•Posterior rib fractures, scapular #, sternal #

•Ruptured frenulum

•High specificity fractures

•Metaphyseal fractures / bucket handle lesion

•Scapular fracture

•Posterior rib fracture

•Spinous process fracture

•Sternal fracture

•Moderate specificity fracture

•Fracture of different ages

•Multiple fracture esp bilateral

•Epiphyseal separation

•Vertebral fracture or subluxation

•Complex skull fracture

•Multiple digital fracture

•I would take history from patients and relatives

•Hx: Inconsisent history, fail to explain injury, delayed presentation, multiple #

•P/E: systemic → growth, failure to thrive, bruises, burn marks, local → #

•Ix: skeletal survey +/- bone scan in <5, take bloods, rule out metabolic bone disease or OI

ADMIT + Multidisciplinary approach + child protection service + social worker

•(remove abuser from environment)

•NAI protocol – child protection meeting

•Mandatory to report (child abuse can be Neglect / physical / sexual / psychological)

•If undiagnosed up to 50% repeated, 10% death

•Ddx: Accident, OI, metabolic bone disease

Q3 How is Non-accidental injury managed?

Xray of skeletally immature patient of his knees

•Left sided Xray shows a corner fracture of the distal femur

•Right sided Xray shows a bucket handle fracture of the proximal tibia

•(bucket handle = corner #, just looking from different view)

•Both in a skeletally immature patient are very suggestive of non accidental injury (NAI)

Red flag signs

•Multiple bruises (Most common symptom is skin lesion)

•Multiple fractures in various stages of healing

•Long bone fxs in infant that is not yet walking

•Metaphyseal Fractures

•1. Corner fxs (primary spongiosa)

•2. Bucket handle

•Transphyseal separation of the distal humerus

•Posterior rib fractures, scapular #, sternal #

•Ruptured frenulum

•High specificity fractures

#	lvl	marL	indent	logical	original note line
1	0	0	0	0	Xray of skeletally immature patient of his knees
2	0	0	0	0	Left sided Xray shows a corner fracture of the distal femur
3	0	0	0	0	Right sided Xray shows a bucket handle fracture of the proximal tibia
4	0	0	0	0	(bucket handle = corner #, just looking from different view)
5	0	0	0	0	Both in a skeletally immature patient are very suggestive of non accidental injury (NAI)
6	0	0	0	0	Red flag signs
7	1	None	None	1	Multiple bruises (Most common symptom is skin lesion)
8	1	None	None	1	Multiple fractures in various stages of healing
9	1	None	None	1	Long bone fxs in infant that is not yet walking
10	1	None	None	1	Metaphyseal Fractures
11	2	914400	0	3	1. Corner fxs (primary spongiosa)
12	2	914400	0	3	2. Bucket handle
13	1	None	None	1	Transphyseal separation of the distal humerus
14	1	None	None	1	Posterior rib fractures, scapular #, sternal #
15	1	None	None	1	Ruptured frenulum
16	0	None	None	0	High specificity fractures
17	1	685800	-228600	2	Metaphyseal fractures / bucket handle lesion
18	1	685800	-228600	2	Scapular fracture
19	1	685800	-228600	2	Posterior rib fracture
20	1	685800	-228600	2	Spinous process fracture
21	1	685800	-228600	2	Sternal fracture
22	0	0	0	0	Moderate specificity fracture
23	1	685800	-228600	2	Fracture of different ages
24	1	685800	-228600	2	Multiple fracture esp bilateral
25	1	685800	-228600	2	Epiphyseal separation
26	1	685800	-228600	2	Vertebral fracture or subluxation
27	1	685800	-228600	2	Complex skull fracture
28	1	685800	-228600	2	Multiple digital fracture
29	0	0	0	0	I would take history from patients and relatives
30	0	0	0	0	Hx: Inconsisent history, fail to explain injury, delayed presentation, multiple #
31	0	0	0	0	P/E: systemic → growth, failure to thrive, bruises, burn marks, local → #
32	0	0	0	0	Ix: skeletal survey +/- bone scan in <5, take bloods, rule out metabolic bone disease or OI
33	0	0	0	0	ADMIT + Multidisciplinary approach + child protection service + social worker
34	0	0	0	0	(remove abuser from environment)
35	0	0	0	0	NAI protocol – child protection meeting
36	0	0	0	0	Mandatory to report (child abuse can be Neglect / physical / sexual / psychological)
37	0	0	0	0	If undiagnosed up to 50% repeated, 10% death
38	0	0	0	0	Ddx: Accident, OI, metabolic bone disease

117. Non-accidental injury

Clean FRCS notes with inline figures

Xray of skeletally immature patient of his knees

Red flag signs

Direct Q&A

Multiple bruises (Most common symptom is skin lesion)

ADMIT + Multidisciplinary approach + child protection service + social worker

Xray of skeletally immature patient of his knees

Red flag signs

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes