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Femur shaft fractures in toddlers and young children: rarely from child abuse.

Published on Jul 1, 2000in Journal of Pediatric Orthopaedics2.046
· DOI :10.1097/01241398-200007000-00010
Richard M. Schwend20
Estimated H-index: 20
,
Chris Werth1
Estimated H-index: 1
,
Andrew Johnston1
Estimated H-index: 1
Abstract
One hundred thirty-nine children younger than 4 years were identified retrospectively from the period of 1993 through 1997 to have an isolated fracture of the shaft of one or both femurs. Abuse was classified as group A (definite, likely, or questionable abuse) or group B (unknown cause, questionable accident, likely accident, or definite accident). The average age of the children was 2.3 ± 1.1 years. Thirteen children, 9% of the total group, average age of 1.1 ± 1.0 years, were likely to have been abused (group A). A total of 126 children, 91% of the total, average age 2.3 ± 1.0 years, sustained their fracture most likely as a result of an accident (group B). Whether a child had not yet achieved walking age (toddler) was the strongest predictor of likely abuse. Ten (42%) of 24 of nonwalking children were in group A, whereas only three (2.6%) of 115 of walking children were in group A (p <0.001). Child Protective Services may have been unnecessary in 42-63% of cases. Unless other evidence of abuse such as an inconsistent story, bruises, or other fractures are present, abuse is very unlikely to be involved in the walking-age child, analogous to the toddler fracture of the tibia.
  • References (14)
  • Citations (85)
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References14
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#1Laurel C. Blakemore (UM: University of Michigan)H-Index: 3
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Last. Robert N. Hensinger (UM: University of Michigan)H-Index: 34
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We reviewed 42 children, aged 1-5 years, with isolated femoral shaft fractures to investigate the possible role of intentional injury in these children. Those children with documented motor vehicle accidents or pathologic fractures were excluded. Follow-up from the Department of Social Services regarding the potential for the fractures being inflicted was obtained. The average age of the children was 3.1±1.2 years ; the fracture was spiral in 28, oblique in six, and transverse in eight ; history...
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#1Patrick J. McMahon (University of Pittsburgh)H-Index: 23
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We reviewed the hospital records of 371 children who were suspected of having been physically abused. Our purpose was to determine specific features that might be used to distinguish injuries resulting from abuse from accidental injuries. Soft-tissue injuries were found in 341 (92 per cent) of these children. Ecchymoses were most common, accounting for 555 (62 per cent) of 892 soft-tissue injuries, and very few had a suspicious pattern. Only thirty-four (9 per cent) of the children had a radiogr...
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#1John M. LeventhalH-Index: 45
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• Objective. —To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. Design. —Case series. Setting. —Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). Patients. —Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse regi...
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• We retrospectively evaluated 138 children younger than 3 years with femoral fractures who presented to the emergency departments of three major Michigan hospitals between 1979 and 1983. Patients were classified into one of the following four subgroups based on presenting history: accident (22%), bone pathology (8%), abuse (10%), and uncertain origin (60%). Distribution of common fracture types among the four subgroups was similar. Of the uncertain group, 22 cases of abuse were identified durin...
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Abstract Pediatric training in child abuse has consistently emphasized a strong association between nonaccidental injuries and spiral fractures of long bones. Isolated spiral tibial fractures of childhood have previously been recognized by the orthopedic specialty to most frequently be accidental in etiology. The authors present evidence that supports a predominantly accidental etiology for isolated spiral tibial fractures of young children. This article presents a series in which 9 of 10 such s...
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