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

Marie Louise H.J. Loos*, Roel Bakx, The FurAHA study group, 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

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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
Issue number12
Early online date7 May 2022
Publication statusPublished - Nov 2022

Bibliographical note

Funding Information:
This work was supported by the Louise Vehmeijer foundation [funding reference number 2016-007 V], the Netherlands.

Publisher Copyright:
© 2022, The Author(s).


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