Bone pathology mimicking non-accidental injury in a child – Bewildered by bones, case report and review of the literature

Physical abuse of children is criminal conduct in the purview of medico-legal sciences and the confirmative diagnosis of ‘child abuse’ is imperative for further legal proceedings. Clinicians play a pivotal role in the protection of children by recognizing and reporting such cases and treating the victims of abuse. To the best of our knowledge, we present the first case report in literature where osteofibrous dysplasia resulted in a pathological fracture in a 10-month-old South-Asian child which resembled the picture of child abuse. The challenges faced by clinicians in the process of analysis of presumed child abuse are numerous and careful formulation and elimination of medical conditions which may mimic non-accidental injury (NAI) is a must, prior to making an incontrovertible diagnosis. The telltale signs of NAI such as soft tissue injuries and fractures in a victimized child should always be evaluated cautiously with the intent of excluding pathologies that may mimic them and the evidence in this regard is seldom in literature. •Numerous medical conditions mimic non-accidental injuries (NAI) in children•Fractures represent the second commonest clinical feature of child abuse•Unusual fractures in children need careful assessment•This report presents a challenging diagnosis of pathological fracture due to osteofibrous dysplasia•Multidisciplinary inputs resulted in correct diagnosis and management