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 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 of a fall was present in 34 and absent in eight. The history 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 appears to be low; unfortunately, there were no discriminating clinical parameters to help to determine which injuries were intentional. The clinician should continue to have a high index of suspicion and have the circumstances investigated if concern exists regarding the fracture.