Safeguarding Children in Trauma and Orthopaedics

Safeguarding, the action taken to protect children from harm, is an important aspect of paediatric care. Orthopaedic surgeons are often the first healthcare professionals to suspect physical abuse or non-accidental injury (NAI) on the basis of children presenting with unexplained bony injury. Physical harm from inflicted injury, a concept that most orthopaedic surgeons are familiar with, is not the only cause for a safeguarding referral and a comprehensive assessment may reveal concerns regarding: neglect, emotional abuse or sexual abuse. Clinicians caring for children, have to consider all of these factors as a cause for concern and organize onward referral. This article focuses on inflicted skeletal injury, how to recognize and investigate it. Typical fractures of concern are discussed and illustrated along with consideration of differential diagnoses.