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Complete Distal Femur Metaphyseal Fracture in Young Children Could Indicate Abuse

A specific type of fracture, a complete distal femur metaphyseal fracture, a complete break of the thigh bone, is often seen in children who have been abused. Fractures are the third most common type of injury resulting from abuse, after bruising and burns.

The authors of this study investigated this type of fracture and its relationship to abuse of children. The researchers reviewed the database of a trauma center and found 29 children in all, 20 children under the age of 1 year (14 boys), who had sustained the fracture. After reviewing the records for the way the children were injured, x-rays, associated injuries, treatment, and outcome, the researchers noted cases of suspected child abuse or neglect.

The 20 younger children were an average of 6 months at the time of injury, but ranged in age from 5 days to 1 year. Five of the children had another long-bone in addition to the study fracture, and 1 child also had a fracture in a rib.

After screening by a social worker, it was found that 10 of the 20 younger children did sustain the fracture from abuse and 5 were considered to be highly suspicious for abuse. The remaining 5 were accidental injuries. None of the 9 children over 1 year appeared to have any signs of abuse.

The authors comment that these types of fractures are the most common type associated with child abuse. Statistics from previous studies say that between 60 percent to 93 percent of such fractures in children who are not yet walking are the result of abuse. They also write, "Nonaccidental femur fractures are more commonly seen in children younger than 1 year, firstborn, children with preexisting brain damage, and those with bilateral [one on each side] fractures."

They recommend that children who are not old enough to walk but present with these fractures be examined for abuse.

References: Alexandre Arkader, MD, et al. Complete Distal Femoral Metaphyseal Fractures; A Harbinger of Child Abuse Before Walking Age. In Journal of Pediatric Orthopedics. October/November 2007. Vol. 27. No. 7.

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