Metaphyseal fractures are considered to be the most specific radiographically detectable injury in abused children, which raised concern for nonaccidental injury in the reported case; however, the symmetrical nature of the injuries coupled with the temporal homogeneity, were not consistent with inflicted injuries, which prompted the layered dissections of all four limbs at autopsy. The histology confirmed that the epiphyseal lesions were not traumatic injuries, but rather secondary to a sickle cell crisis. The case then quickly changed from one of inflicted injury to an instructive case for pediatric clinicians, radiologists, and pathologists. Although sickle cell disease/sickle cell trauma (SCD/SCT) is not one of the classic mimickers of child abuse, unusual orthopedic pathologies can and do occur; they may appear as inflicted injury on a skeletal survey. This paper summarizes the boy's clinical history, which was significant only for autism, with moderate to severe global developmental disorder. During the 3 weeks prior to his death, he had been brought to his family physician's office three times with a complaint of left leg pain. Radiographs on two separate days showed only mild soft-tissue swelling near the midshaft of the left tibia, with no evidence of fractures, arthritic change, or other bony abnormality. There was no history of SCD in the boy or in any first-degree relative, although it is not known whether the parents had undergone screening for SCD prior to immigrating to Canada from Ghana. This paper presents the details of the autopsy procedures and findings, along with ancillary tests. 4 figures and 21 references