Non-accidental injury (NAI) is a common differential diagnosis in children presenting with unexplained fractures. Multi-agency investigations and strategy meetings are completed at hospital, and although necessary, can create anxiety and stress for the family. Differentials such as osteogenesis imperfecta and rare neuropathies are additional possibilities

Background

This case study presents a two year old admitted via the emergency department (ED) with right tibia and fibula fractures. Additional concerns included marked tenderness and calf swelling with no mechanism of injury witnessed by either parent. Discussions with consultant radiologists specialising in children’s safeguarding suggested significant force from a direct anterior or posterior blow would have been required.