Undiagnosed abuse in children with femoral fractures - Tips from Other Journals

Date: Dec, 1990

Physical abuse is a major cause of injury in young children. While children with multiple burns, welt marks or multiple fractures are commonly recognized as victims of abuse, abuse may not be suspected in children who present with a single fracture.

Dalton and colleagues studied the incidence of physical abuse in 138 children under three years of age who presented to an emergency department with femoral fractures. On the basis of the presenting history, abuse was initially suspected in 10 percent of the cases, accidental injury in 22 percent and bone pathology in 8 percent. In the remaining 60 percent of cases, fractures were of uncertain origin. During subsequent investigation and follow-up, however, an additional 29 cases of abuse were identified.

The high percentage of abuse (31 percent) in these children led the investigators to make the following recommendations. Femoral fracture in children under three years of age should arouse suspicion of child abuse. When the cause of the fracture is unclear, the child should be admitted to the hospital for evaluation. A multidisciplinary medical and social services team trained in detecting abuse should evaluate the child, and the cause of the fracture should be determined before the child is released from the hospital. (American Journal of Diseases of Children, August 1990, vol. 144, p. 875.)

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