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Age of children with femoral fractures

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Femoral fractures in the abuse group occurred predominantly in children less than one year of age 1, 3-10,12,13,15-18
  • Abused children less than 18 months of age (17.5%, 66/377) were more likely to sustain a femoral fracture than those aged 18 months or over (5.7%, 7/123).  In contrast, accidentally injured children were more likely to sustain a femoral fracture aged 18 months old or over than below this age (p<0.001) 11
  • The odds ratio (OR) for abuse in a child aged less than 18 months with a femoral fracture was 1.8 (95%CI 1.2, 2.7) (p=0.005) 11
  • The OR for abuse in a child aged 18 months or over with a femoral fracture was 0.3 (95%CI 0.1, 0.7) (p=0.003) 11
  • A third of isolated femoral fractures in children less than three years of age were abusive 5
  • Spiral fracture was the most common abusive fracture in children under 15 months old (p=0.05); over this age spiral fracture was not significantly commoner in abused children 5
  • No specific fracture type in children aged 0 – 3 years was associated with abuse 7
  • There was a highly significant association between femoral fracture in non-ambulant children and abuse 7,14
  • The median age of the abuse cases was lower (4 months) versus accidental (26.2 months) (p<0.001) 2

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  1. Anderson WA. The significance of femoral fractures in children. Annals of Emergency Medicine. 1982;11(4):174-177 [Pubmed]
  2. Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS. Femur fractures in the pediatric population: abuse or accidental trauma? Clinical Orthopaedics and Related Research. 2011;469(3):798-804 [Pubmed]
  3. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse. Journal of Pediatric Orthopaedics. 1983;3(5):583-586 [Pubmed]
  4. Blakemore LC, Loder RT, Hensinger RN. Role of intentional abuse in children 1 to 5 years old with isolated femoral shaft fractures. Journal of Pediatric Orthopaedics. 1996;16(5):585-588 [Pubmed]
  5. Dalton HJ, Slovis T, Helfer RE, Comstock J, Scheurer S, Riolo S. Undiagnosed abuse in children younger than 3 years with femoral fracture. American Journal of Diseases of Children. 1990;144(8):875-878 [Pubmed]
  6. Gross RH, Stranger M. Causative factors responsible for femoral fractures in infants and young children. Journal of Pediatric Orthopaedics. 1983;3(3):341-343 [Pubmed]
  7. Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J. Femoral fractures in children younger than three years: the role of nonaccidental injury. Journal of Pediatric Orthopaedics. 2008;28(3):297-302 [Pubmed]
  8. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  9. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  10. Loder RT, Feinberg JR. Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids' inpatient database. Journal of Pediatric Orthopedics. 2007;27(4):421-426 [Pubmed] (Erratum in Journal of Pediatric Orthopedics. 2008;28(6):699)
  11. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  12. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  13. Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta 3rd. Accidental and nonaccidental femur fractures in children. Clinical Orthopaedics and Related Research. 2000;(376):96-105 [Pubmed]
  14. Schwend RM, Werth C, Johnston A. Femur shaft fractures in toddlers and young children: rarely from child abuse. Journal of Pediatric Orthopaedics. 2000;20(4):475-481 [Pubmed]
  15. Skellern CY, Wood DO, Murphy A, Crawford M. Non-accidental fractures in infants: risk of further abuse. Journal of Paediatrics and Child Health. 2000;36(6):590-592 [Pubmed]
  16. Thomas SA, Rosenfield NS, Leventhal JM, Markovitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991;88(3):471-476 [Pubmed]
  17. Wellington P, Bennet GC. Fractures of the femur in childhood. Injury. 1987;18(2):103-104 [Pubmed]
  18. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]




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