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Non-accidental injury

Radiology Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK

• The radiology of non-accidental injury (NAI) requires meticulous attention to detail.
  
• The many normal variants found in the developing skeleton provide numerous pitfalls to the diagnosis.
  
• The expert must fairly balance the need to protect the child against just treatment of the carers.
  
• Many of the fractures, e.g. rib and metaphyseal fractures, are highly suggestive of NAI, but many, e.g. undisplaced long bone fractures, are not. Correlation with the clinical history is mandatory.
  
• As many of the fractures are clinically asymptomatic, e.g. rib and metaphyseal fractures, radiology has a significant role in the diagnosis.
  
• The differential diagnosis is mainly accidental trauma, but birth injuries, prematurity and skeletal dysplasias may need to be considered.
  

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