ROLE OF INTENTIONAL ABUSE IN CHILDREN 1 TO 5 YEARS OLD WITH ISOLATED FEMORAL-SHAFT FRACTURES

We reviewed 42 children, aged 1-5 years, with isolated femoral shaft f ractures to investigate the possible role of intentional injury in the se 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 inflic ted 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 eigh t; history of a fall was present in 34 and absent in eight. The histor y was considered suspicious for intentional injury in 14 children. In all 42 children, only one fracture was documented to be inflicted; one other child had prior documentation of intentional injury. From this review, the likelihood of intentional injury to the femoral shaft appe ars to be low; unfortunately, there were no discriminating clinical pa rameters to help to determine which injuries were intentional. The cli nician should continue to have a high index of suspicion and have the circumstances investigated if concern exists regarding the fracture.