When the Bruise Doesn’t Match the Bone: Clinical- Radiological Discrepancy in a Fabricated Forearm Injury

Abstract

Fabricated injuries, also known as feigned or self-inflicted injuries, are deliberately produced wounds created either by the
individual themselves or with assistance, usually for deceptive medicolegal purposes such as false accusations, diversion of
suspicion, sympathy seeking, or financial and legal gain. These injuries are typically inflicted on easily accessible and nonvital
body parts to simulate assault, defensive injuries, strangulation, or sexual offences, while carefully avoiding serious harm.
From a forensic standpoint, fabricated injuries present a significant challenge as they may closely resemble genuine traumatic
wounds, necessitating meticulous correlation between history, clinical findings, and radiological evidence. We report a case
of a 75-year-old male who presented to the emergency department of a tertiary care hospital alleging assault with multiple
sharp and blunt weapons. Clinical examination revealed multiple injuries involving the upper limbs and right shoulder. The
radiological evaluation demonstrated a healed fracture of the shaft of the left ulna with established callus formation at the site
of the reported bruise, indicating that the fracture was more than three weeks old and temporally inconsistent with the alleged
recent assault. The other injuries showed no radiological evidence of bony involvement. The marked discrepancy between
the clinical presentation, radiological findings, and injury chronology raised suspicion of fabrication, particularly with respect
to the left forearm injury. This case underscores the importance of integrating clinical examination with forensic radiology and
maintaining awareness of characteristic fabrication patterns. Accurate identification of fabricated injuries is essential to prevent
misuse of medicolegal systems and ensure fair judicial outcomes.