Bilateral fibular fractures in a pre-ambulant infant

Area of Science:

• Pediatric Radiology
• Child Abuse Detection
• Skeletal Trauma

Background:

• Bilateral long-bone fractures in young children often raise concerns for inflicted injury (physical abuse).
• Healing fractures of the fibulae, especially bilateral ones, are uncommon and can be highly suspicious for abuse depending on the child's age.
• Distinguishing between inflicted and accidental fractures is critical in pediatric cases.

Observation:

• A case of bilateral, healing, undisplaced fibular fractures in a pre-ambulant infant is presented.
• The fractures were located in almost identical positions on both fibulae.
• Caregivers provided a video demonstrating the infant repeatedly banging his legs against a playpen's metal frame.

Findings:

• Radiographic evidence of bilateral fibular fractures was observed.
• The documented mechanism of injury (banging legs on playpen) correlated with the fracture locations.
• The mechanism was deemed consistent with the observed radiographic abnormalities, supporting self-infliction.

Implications:

• This case underscores the importance of considering self-inflicted injuries in infants, even with seemingly suspicious fracture patterns.
• Radiologists and clinicians should carefully evaluate the reported mechanism of injury alongside imaging findings.
• Accurate diagnosis prevents misattribution of abuse and ensures appropriate management.