Figure 5.

A distal femur fracture (short arrow) was diagnosed in a 16-month old toddler. The parents did not report any injury and presented their child only on the following day, in spite of severe pain. However, the image additionally shows an older proximal tibial fracture (long arrow) that is definitely more difficult to detect. The child was not yet walking, which made an accidental pathogenesis—combined with the lacking medical history—extremely unlikely. In consideration of psychosocial aspects, we diagnosed severe and prolonged abuse. Consequently, the child protection / youth welfare services implemented a protection plan for the child.