Undiagnosed abuse in children younger than 3 years with femoral fracture
H. J. Dalton, T. Slovis, R. E. Helfer, J. Comstock, S. Scheurer and S. Riolo
Department of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh, PA 15213.
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 during admission
and 7 additional cases were found at a later date. The total number of
femoral fractures secondary to abuse was 43 (31%) of 138. Children younger
than 3 years presenting with a femoral fracture should evoke a high
suspicion for abuse.
