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Background and purpose ��� Physical abuse of children, i.e., nonaccidental injury (NAI) including abusive head trauma (AHT) is experienced by up to 20% of children; however, only 0.1% are diagnosed. Healthcare professionals issue less than 20% of all reports suspecting NAI to the responsible authorities. Insufficient knowledge concerning NAI may partly explain this low percentage. The risk of NAI is heightened during health and socioeconomic crises such as COVID-19 and thus demands increased awareness. This review provides an overview and educational material on NAI and its clinical presentation. Methods ��� We combined a literature review with expert opinions of the senior authors into an educational paper aiming to help clinicians to recognize NAI and act appropriately by referral to multidisciplinary child protection teams and local authorities. Results ��� Despite the increased risk of NAI during the current COVID-19 crisis, the number of reports suspecting NAI decreased by 42% during the lockdown of the Danish society. Healthcare professionals filed only 17% of all reports of suspected child abuse in 2016. Interpretation ��� The key to recognizing and suspecting NAI upon clinical presentation is to be aware of inconsistencies in the medical history and suspicious findings on physical and paraclinical examination. During health and socioeconomic crises the incidence of NAI is likely to peak. Recognition of NAI, adequate handling by referral to child protection teams, and reporting to local authorities are of paramount importance to prevent mortality and physical and mental morbidity.

Five to six percent of neurofibromatosis type 1 (NF1) patients have congenital tibial dysplasia, the lesion leading to congenital pseudarthrosis (CP). There is an equal sex distribution of NF1, but more boys than girls with NF1 have CP. Approximately 50% of patients with CP have NF1. Gait analysis in patients operated on for CP of the tibia showed that intramedullary rodding across the ankle joint resulted in a gait that was no more efficient than that of the amputee with a well functioning prosthesis. Three articles dealt with llizarov treatment of tibial CP, which is usually indicated after unsuccessful rodding and bone grafting. The union rate varied between 64% and 83%. None of these articles accounted for the functional outcome. Free vascularized fibular grafting seems at least as effective as llizarov treatment in obtaining union, and the functional outcome is good in most patients. This latter technique appears to be preferable in the rare CP of the upper extremity.