Dr. Alan Stotts from the University of Utah has written a fairly comprehensive review of this topic. He reviewed the recent literature for orthopedists. He reported on the diagnosis and treatment of children and teens with injuries caused by child abuse.
Soft tissue injuries and fractures are the most common conditions seen by the orthopedic surgeon. The surgeon must also be on the alert for any internal injuries and unseen trauma that may be present. X-rays and CT scans may be needed in suspicious cases.
There are many red flags to alert the health care professional of possible child abuse. Certain patterns of injury may be recognized. For example, watch for finger marks or any bruising that goes all the way around an arm or leg. Burns and bite marks must be reviewed carefully.
Fractures and multiple injuries are rare from simple falls in young children. Fractures are very suspicious in children who aren’t walking yet or who are just starting to walk. Injuries at different stages of healing is a major red flag.
There are some specific types of bone fractures that raise the suspicion of child abuse. These include the corner fracture or bucket handle fracture of the long bones. A section of the growing bone at the ends of long bones is pulled away along with a piece of the bone. Such injuries are not likely with simple falls.
Posterior rib fractures are also red flag injuries. These fractures are distinctly different from common fractures seen in children from accidents or falls.
A careful survey of any child, espcially under the age of two is warranted when there are any red flags or suspicious signs of abuse. Oblique X-ray views of the ribs may be warranted in such circumstances.