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NAI – fracture pattern — RACP Paediatrics MCQ

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ModerateEmergencyNAI – fracture patternRACP Paediatrics

A 4-month-old non-mobile infant presents with an unexplained swollen leg. Skeletal survey reveals bilateral healing posterior rib fractures, a classic metaphyseal corner fracture of the distal tibia, and a healing humeral fracture. What pattern is most concerning for non-accidental injury?

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Correct answer: C — Multiple rib fractures of different ages

Multiple rib fractures of different ages in a non-mobile infant are highly specific for non-accidental injury (NAI). Posterior rib fractures are particularly concerning as they result from squeezing forces. Classic metaphyseal corner (bucket-handle) fractures are also highly specific for NAI. Multiple fractures of different ages indicate repeated episodes of trauma.

Reference: RCH Melbourne – 2023 – Child Abuse CPG; RACP Paediatric Curriculum – Child Protection