Case 24

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A 4-year-old boy complained of arm pain and was brought to the emergency department. There was no history of a fall or other injury. He lives at home with his mother and was recently in the care of his mother’s boyfriend while she was out of town. The radiograph below indicates the finding of a nightstick fracture of the ulna.

You have reported this finding to child protective services, but they are unaware of the significance of the injury. When you explain your concerns, they ask you to put your concerns in writing.

x-ray of arm, details below

Accessible Version

A radiograph of a left arm with a mid-ulnar, linear, horizontal lucency that is partway through the bone.

You write a brief note to the child protective worker that includes which of the following formulations?

A. In my opinion, this child (name here) has suffered from non-accidental trauma. The ulna fracture, also called a nightstick fracture, is suspicious for a direct blow to the arm.

B. This child has a nightstick fracture, and it is suspicious for child abuse.

C. The finding of a fracture without a history of accidental fall confirms that child abuse occurred.

D.The finding of a nightstick fracture was likely caused by the mother’s boyfriend.