Scenario Summary

• Infant (5 months old) — non-mobile baby
• Injury: Spiral fracture of the humerus
• No clear history of trauma (parents say not moving arm)
• Timing: Presented on Friday; ortho wants to see him Monday
• Consultant asks: “What is the best action now?”

Key Concept

A spiral fracture in a non-mobile infant is highly suspicious for non-accidental injury (NAI).
Infants this age cannot generate such injuries themselves (e.g., by rolling).
Therefore, this is a child protection emergency.

Step-by-Step Reasoning

1. Recognize this as potential physical abuse.
   • Non-accidental injury must be suspected.
2. Safety first: The child must not go home until abuse is excluded.
3. Immediate action:
   • Admit the child to hospital for safety and full assessment.
   • Initiate child protection procedures — involve paediatrics and social services.
   • A skeletal survey and other investigations will follow after admission.

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Answer Choices Analysis

Option	Discussion
a) Admit the child	✅ Correct — Ensures safety, allows full evaluation, and prevents further harm.
b) Skeletal survey	Needed, but not the first step — it’s part of the NAI work-up after admission.
c) Refer to social services	Essential, but done immediately after admission, not as the first step alone.
d) Advice to go home	❌ Unsafe — high risk of further harm.
e) More investigations	❌ Not appropriate before ensuring safety.

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Final Answer

a) Admit the Child

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Key Learning Point

In any non-mobile baby with unexplained fracture or injury,

👉 “If you suspect non-accidental injury, admit and protect the child first.”

Investigations and social service referrals follow after ensuring safety.

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