The work group recognizes that the most important elements in evaluating a child for abuse are a complete history and physical exam with attention to the signs and symptoms of child abuse. The work group defines “evaluating” a child for abuse however, as not only these routine elements, but also including direct communication with the patient’s pediatrician or family doctor, consultation with the child abuse team at institutions where this may be available, and selective ordering of a skeletal survey by the orthopaedist when considered appropriate by the treating physician. In cases of possible child abuse, these professionals can add valuable input, based on experience, which increases the probability of identifying patients who may be at increased risk.15
In addition, the work group emphasizes that children who are not yet walking and sustain a femur fracture are at particular risk for abuse7, so one must make every attempt to identify these patients. One of the studies2 reports 48 of 49 child abuse-related femur fractures occurred in the less than three year old age group. This author found that in 332 femur fractures in children 0-3 years of age forty-eight of them were due to abuse. Accordingly, there were 451 children, four to twelve years of age, who had femur fractures and only one child in this age group was confirmed as abused. There were no cases of child abuse identified in the thirteen to seventeen year old age group. The work group acknowledges that this study is not exclusively reporting data on shaft fractures and has isolated the data specific to shaft fracture in the following data tables. However, the study does illustrate the need to focus on the patients who are less than three years old.
Estimates of child abuse suggest that the incidence is underreported and the consequences of missing it result in serious complications including death.2
- (1) Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am. 1999;81:500-509.
- (16) Miettinen H, Makela EA, Vainio J. The incidence and causative factors responsible for femoral shaft fractures in children. Ann Chir Gynaecol. 1991;80:392-395.
- (2) Rewers A, Hedegaard H, Lezotte D et al. Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study. Pediatrics. 2005;115:e543-e552.