Femur Fractures in the Pediatric Population: Abuse or Accidental Trauma?
Keith Baldwin, MD, MPH, MSPT, Nirav K. Pandya, MD, Hayley Wolfgruber, BA,Denis S. Drummond, MD, and Harish S. Hosalkar, MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho). Clin Orthop Relat Res. 2011 Mar; 469(3): 798–804. Published online 2010 Apr 7. doi: 10.1007/s11999-010-1339-z
The authors compared 70 patients with femur fractures from abuse with 139 with fractures not from abuse in patients less than 2 years of age. The authors identified 3 risk factors for abuse: 1) a history suspicious for abuse, 2) physical or radiographic evidence of prior injury, 3) age younger than 18 months. The likelihood of abuse was calculated based on the presence of these risk factors:
Likelihood of Abuse
- 0 risk factors - 4% chance
- 1 risk factor - 29% chance
- 2 risk factors - 87% chance
- 3 risk factors - 92% chance