Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

FurAHA Study Grp, Marie-Louise H. J. Loos*, Roel Bakx, J. H. Allema, Frank W. Bloemers, Jan A. ten Bosch, Michael J. R. Edwards, Jan B. F. Hulscher, Claudia M. G. Keyzer-Dekker, Egbert Krug, Victor A. de Ridder, W. Richard Spanjersberg, Arianne H. Teeuw, Hilco P. Theeuwes, Selena de Vries, Ralph de Wit, Rick R. van Rijn

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.

Objective This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.

Materials and methods This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.

Results The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR +5.98) and 18-23 months (14%, LR +3.74). Indicators of neglect were age 6-11 months (18%, LR +4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.

Conclusion It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/ neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.

Original languageEnglish
Pages (from-to)2359–2367
Number of pages9
JournalPediatric radiology
Volume52
Early online date7-May-2022
DOIs
Publication statusPublished - Nov-2022

Keywords

  • Child abuse
  • Children
  • Femur
  • Fractures
  • Infants
  • Inflicted trauma
  • Radiography
  • TIBIAL FRACTURES
  • ABUSE
  • PATTERNS
  • INJURY
  • TODDLERS
  • INFANTS

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