Complete recognition and documentation of skeletal injury is critical for an accurate determination of child abuse. Several fracture types are highly specific to nonaccidental injury in infants. These pertain to posterior rib, scapular, metaphyseal, and spinous process fractures. Radiologic detection of these injuries is difficult in infants, especially when acute. The autopsy technique described in this paper requires incising and reflecting skeletal muscles in order to expose the bones and costal osseous joints in situ, increasing the opportunity to recognize skeletal injury. Fractured bones or bones that appear atypical are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. In order to aid in reconstruction of the decedent, long bones are replaced with wooden dowels, and the chest cavity is packed with the organ bag. This technique is invasive and labor intensive. Complete application of this autopsy technique may increase an autopsy by as much as 2 hours, but it is necessary in cases in which the pathologist has reasonable suspicion of acute or remote trauma. Two recent cases investigated by the Harris County Medical Examiner's Office (Texas) illustrate the success of this technique in recognizing hidden skeletal fractures. 1 table, 6 figures, and 13 references