Musculoskeletal manifestations of child maltreatment represent common presentations to the emergency department. The recognition of child maltreatment is an essential role for the practicing emergency physician, as it can directly prevent further serious injury. Orthopedic trauma in children presents very differently than that in adults. Understanding of the unique properties of pediatric bone as well as the developmental capabilities of children in relation to injury mechanism is essential in the interpretation of these injuries. Children younger than 3 years are most vulnerable to bony injury from child maltreatment. Common presenting findings include complex skull fractures, rib fractures, long bone fractures, and metaphyseal corner fractures. Skeletal survey remains the mainstay of detection for injuries, but recent work has also elucidated a role for other modalities in fracture detection. Management should include proper orthopedic interventions, along with mandatory reporting of possible maltreatment to the local child protective services or other equivalent agency.