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August 1990

Undiagnosed Abuse in Children Younger Than 3 Years With Femoral Fracture

Author Affiliations

From the Department of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh (Pa) (Dr Dalton); Wayne State University School of Medicine and the Department of Pediatric Radiology, Children's Hospital of Michigan (Dr Slovis), Detroit; the Department of Pediatrics, College of Human Medicine, Michigan State University, East Lansing (Drs Helfer and Scheurer and Ms Riolo); and the Department of Pediatrics, University of Arizona, Tucson (Dr Comstock).

Am J Dis Child. 1990;144(8):875-878. doi:10.1001/archpedi.1990.02150320039022

• 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.

(AJDC. 1990;144:875-878)