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Fractures suspicious for abuse — MRCPCH FOP MCQ

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HardSafeguardingFractures suspicious for abuseMRCPCH FOP

A 7-month-old infant has a swollen painful thigh with no clear trauma. X-ray shows a femoral fracture and skeletal survey identifies posterior rib fractures at different healing stages. What is the most likely diagnosis?

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Correct answer: E — Physical abuse

A femoral fracture in a non-mobile infant with posterior rib fractures of different ages is highly suspicious for physical abuse. Osteogenesis imperfecta is a differential, but the injury pattern and developmental stage require safeguarding action. A cruising fall is not plausible for a 7-month-old non-mobile infant. The pearl is that medical differentials should be considered while safeguarding proceeds.

Reference: NICE CG89 Child maltreatment; RCPCH Child Protection Companion