An 8-year-old boy with a history of severe mental retardation, cerebral palsy, and seizure disorder was brought to the emergency room because of a lump in the anterior aspect of upper right side of the chest. His mother denied any history of trauma, other than a fall from a wheelchair while he was on the school bus. Initial roentgenograms showed a healing fracture of the right clavicle (Fig 1). A healing fracture involving the right distal shaft of the ulna was noted by radiographic long-bone skeletal survey (Fig 2). No history of trauma explained the ulnar fracture. Child abuse was suspected, and the child was admitted to the hospital.
Significant history included a normal birth and neonatal period. At 6 weeks of age the patient was the victim of a house fire and received severe burns. Secondary to anoxia he developed seizures, cerebral palsy, and developmental delay. At the time
Zeiss J, Wycliffe ND, Cullen BJ, Conover S, Wood BP. Radiological Case of the Month. Am J Dis Child. 1988;142(12):1367–1368. doi:10.1001/archpedi.1988.02150120121054