The left thigh x-rays shows concerning injury in a neonate. There is fracture of the upper shaft of femur with abundant callus. This should be treated as a non accidental injury and the patient should be managed as such. History by parent of increasing sleepiness should raise concerns for intracranial bleed/ subdural bleed and a CT scan of the head is warranted to rule out one.

The neonate was admitted and had further investigations. Child protection authorities were involved. Intracranial bleed was ruled out post CT imaging. Skeletal survey revealed multiple posterior rib fractures.