Non-accidental injury

Case contributed by Dr Andrew Dixon

Presentation

Brought into hospital by Mother after she noticed her to be irritable after inadvertent forceful twisting of the thigh when changing diaper.

Patient Data

Age: 6 weeks
Gender: Female

Pelvis and right femur

X-ray

Spiral midshaft right femoral fracture. 

Bone scan

Nuclear medicine

Focal increased uptake in the right 4th to 7th ribs posteriorly consistent with fractures.

Case Discussion

Spiral fracture of any long bone in a non-mobile infant is always worrying for non-accidental injury (child abuse). Radiographic skeletal survey was performed in this case but no other injury was seen.  Bone scan however revealed focal increased uptake in the right 4th to 7th ribs posteriorly consistent with fractures.  This is the most common site of non-accidental rib fracture in infants due to a compressive squeezing force applied to the chest.

The lack of tracer uptake around the right femur fracture does not necessarily mean the fractures happened at different times as the degree of displacement of the femoral fracture may have prevented osteoblastic activity.

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