A radiologist says he alerted child protection services when a baby, who later died at the hands of her abusive father, was admitted to an Adelaide hospital with a broken leg.
Baby Ebony died on or about November 8, 2011 at four months old after suffering horrific injuries.
Her father was jailed for nine years for criminal neglect.
Radiologist Christopher Pozza has told an inquest he suspected a fracture to Ebony's thigh was non-accidental when she presented at Adelaide's Queen Elizabeth Hospital in August 2011.
Ebony's parents said the father was holding the child when she overbalanced and fell onto her pram, trapping her leg between the wheels, the inquest has heard.
"In my opinion, the force required to fracture this bone is not consistent with the stated fall," Dr Pozza told Adelaide Coroner's Court on Tuesday.
"A fracture of the femur requires a significant force.
"Something like a vehicle accident or a fall from a significant height - out of a tree or a playground."
Dr Pozza said a red flag went up and child protection authorities were notified when he saw the "spiral" fracture in the X-ray .
"To make sure the appropriate measures were taken," he said.
The experienced clinical radiologist said the amount of bone regrowth seen in the X-ray suggested the fracture was older than the two days the parents claimed it to be.
"Quite clearly the evidence suggested the fracture was at least five days old," he said.
Ebony was later transferred to the Women and Children's Hospital.
South Australian child services eventually accepted the parents' explanation after this hospital made conclusions and a subsequent visit by a social worker was deemed positive.
Dr Pozza said he was surprised child protection services did not ask for his opinion on the injury.
"My findings were short, sharp and to the point," he said.
"I could not stress highly enough my concerns."
Dr Pozza said non-accidental injuries were the most common cause of a fracture like Ebony's for a child under one year.
Ebony suffered multiple skull fractures and dozens of fractures to her ribs, collarbone, leg, fingers and toes during her short life.
Her mother was a ward of the state in NSW when she fell pregnant and moved to Adelaide, but the guardianship was not transferred.
The inquest earlier heard the family had completely disengaged from SA child protection services at the time of Ebony's death.
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