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Femur Shaft Fractures in Toddlers and Young Children: Rarely from Child Abuse

Schwend, Richard M. M.D.; Werth, Chris B.A.; Johnston, Andrew M.D.

Journal of Pediatric Orthopaedics: July-August 2000 - Volume 20 - Issue 4 - p 475-481

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.

Study conducted at the Children's Hospital, Buffalo, New York, U.S.A.

From the Department of Orthopaedic Surgery, University at Buffalo, Children's Hospital, Buffalo, New York, U.S.A.

Address correspondence and reprint requests to Dr. R. M. Schwend, Department of Orthopaedic Surgery, Children's Hospital, 219 Bryant Street, Buffalo, NY 14222, U.S.A. E-mail:

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

© 2000 Lippincott Williams & Wilkins, Inc.