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

被引:60
作者
Schwend, RM [1 ]
Werth, C [1 ]
Johnston, A [1 ]
机构
[1] SUNY Buffalo, Childrens Hosp, Dept Orthopaed Surg, Buffalo, NY USA
关键词
child abuse; femur; femur shaft fracture; suspected child abuse and neglect;
D O I
10.1097/00004694-200007000-00010
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
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.
引用
收藏
页码:475 / 481
页数:7
相关论文
共 16 条
[1]   THE SIGNIFICANCE OF FEMORAL FRACTURES IN CHILDREN [J].
ANDERSON, WA .
ANNALS OF EMERGENCY MEDICINE, 1982, 11 (04) :174-177
[2]  
BEALS RK, 1983, J PEDIATR ORTHOPED, V3, P197
[3]   Role of intentional abuse in children 1 to 5 years old with isolated femoral shaft fractures [J].
Blakemore, LC ;
Loder, RT ;
Hensinger, RN .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1996, 16 (05) :585-588
[4]   UNDIAGNOSED ABUSE IN CHILDREN YOUNGER THAN 3 YEARS WITH FEMORAL FRACTURE [J].
DALTON, HJ ;
SLOVIS, T ;
HELFER, RE ;
COMSTOCK, J ;
SCHEURER, S ;
RIOLO, S .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1990, 144 (08) :875-878
[5]   THE INCIDENCE OF FEMORAL-SHAFT FRACTURES IN CHILDREN AND ADOLESCENTS [J].
HEDLUND, R ;
LINDGREN, U .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1986, 6 (01) :47-50
[6]  
HELFER RE, 1977, PEDIATRICS, V60, P533
[7]  
KING J, 1988, J PEDIATR ORTHOPED, V8, P585
[8]   FRACTURES IN THE UNDER-3-YEAR-OLD AGE COHORT [J].
KOWALVERN, A ;
PAXTON, TP ;
ROS, SP ;
LIETZ, H ;
FITZGERALD, M ;
GAMELLI, RL .
CLINICAL PEDIATRICS, 1992, 31 (11) :653-659
[9]   FRACTURES IN YOUNG-CHILDREN - DISTINGUISHING CHILD-ABUSE FROM UNINTENTIONAL INJURIES [J].
LEVENTHAL, JM ;
THOMAS, SA ;
ROSENFIELD, NS ;
MARKOWITZ, RI .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1993, 147 (01) :87-92
[10]  
Loder R T, 1991, J Orthop Trauma, V5, P428, DOI 10.1097/00005131-199112000-00007