Which finding would be most concerning for non-accidental trauma when multiple injuries are present?

• A. A single bruise on the shin
• B. A minor abrasion
• C. Fx of long bones
• D. A sunburn on the back

Answer: (C)

When injuries appear in combination, the pattern and severity guide concern for abuse. A fracture of a long bone is the most worrisome in this context because it reflects a level of force that is unlikely from simple accidents, especially in a child with multiple injuries. Such fractures can also occur in different ages of healing, suggesting ongoing trauma. In contrast, a single bruise or minor abrasion can easily be accidental, and a sunburn is not a traumatic injury. Therefore, the presence of a long-bone fracture among multiple injuries raises the strongest red flag for non-accidental trauma.