The Role of the Orthopaedic Surgeon in the Identification and Management of Nonaccidental Trauma

Sheena C. Ranade, MD; Abigail K. Allen, MD; Stephanie A. Deutsch, MD


J Am Acad Orthop Surg. 2020;28(2):53-65. 

In This Article


Most children presenting to the orthopaedic surgeon with fracture will not be victims of NAT; however, fracture is the second most common presentation of NAT after bruising. It is vital for NAT to remain in the differential diagnosis for all orthopaedic patients. When possible, identification of sentinel lesions and notification of authorities as a mandated reporter may prevent ongoing abuse and even fatality. Mandatory reporting in good faith is without legal liability, and as such, the orthopaedic surgeon should use their understanding of historical risk factors coupled with clinical patterns of injury to make educated decisions on when to report without fear of repercussions. As a frontline health provider for children with skeletal issues, orthopaedic surgeons are in a particularly vital position to identify and protect these children.