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Unexplained fracture — DCH MCQ

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HardSafeguardingUnexplained fractureDCH

A 20-month-old girl has a spiral fracture of the femur. The explanation is that she fell from a sofa, but she was brought in two days later and has bruises of different ages on the trunk. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Non-accidental injury

A femoral fracture with delayed presentation, inconsistent mechanism and trunk bruises of different ages is concerning for non-accidental injury. Bone fragility disorders can be considered, but they do not remove the need for safeguarding assessment. The pearl is that safeguarding and medical differential diagnosis can proceed in parallel.

Reference: NICE CG89; RCPCH Child Protection Companion