Long bone fracture in a non-ambulatory infant: A possibility of non-accidental injury

Abstract

Background: A wide range of medical conditions can mimic non-accidental injury (NAI) in a child. A fracture is one of those. When a non-ambulatory infant presents with a fracture, it may lead the clinician to lean on a non-accidental injury rather than a pathological fracture, which is less common. Case study: A two-month-old infant was admitted to the surgical ward of a tertiary care children's hospital with the complaint of crying while touching the right lower limb for two days. There was no history of trauma. Social history didn't reveal any red flags. On examination, the child was found to be afebrile and irritable. The X-ray of the same limb revealed a fracture of the tibia. On the very first day, doctors suspected NAI and informed the police. There was an accusation against the mother by her husband and close relatives. Following that, the mother attempted deliberate self-harm. A skeletal survey revealed a wedge fracture of the thoracolumbar vertebra, and a diagnosis of a mild variant of osteogenesis imperfecta (OI) was made. Conclusion: The OI is a genetic disorder leading to bone fragility and is one of the leading causes of pathological fractures in the pediatric population. Differentiating between traumatic and pathological fractures can be challenging. Especially in children, fracture is the second most common presentation of NAI. This case highlights the potential for misdiagnosing medical conditions as NAI. Recognizing non-accidental injury is essential to treating and preventing such episodes, but an overenthusiastic diagnosis of NAI could put the family through needless stress. It could have been avoided with stepwise treatment, a multidisciplinary approach, and proper communication with the parents.