You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is A small boy who is brought to the emergency department by his parents is found to have a spiral fracture of the femur, with a variety of ecchymoses. What is the most likely cause of the injuries – and explain in detail?
The fracture can occur in all the four options given in questions.
But, a variety of ecchymoses suggests child abuse -

"Bruises are the most common manifestation of child abuse and may be found on anybody surface".