Distal femoral metaphyseal fractures - Academy News at the 2007 AAOS Annual Meeting

Distal femoral metaphyseal fractures can indicate child abuse

By Jennie McKee

A child who has not yet reached walking age, but has a complete distal femoral metaphyseal fracture, may be a victim of child abuse, according to poster exhibit P255. Orthopaedic surgeons who see this injury should inquire about a previous history of abuse and take appropriate steps to prevent further abuse.

Diaphyseal or epiphyseal corner femur fractures are considered to be the most prevalent indicator of child abuse in children younger than one year old. But in half of the cases of metaphyseal femur fractures at two Level I pediatric trauma centers, researchers confirmed a previous history of abuse; abuse was suspected in an additional 25 percent of the cases.

Anterior-posterior (left) and lateral (right) radiographs of the right knee of a 6-month old boy who sustained a nonaccidental injury and developed a complete distal femoral metaphyseal fracture (arrows).

In a retrospective study of the trauma databases at two Level 1 U.S. pediatric trauma centers, researchers found 117 pediatric patients treated from 1995 to 2005 for a complete distal femur fracture. Among these patients, 29 (24.8 percent) sustained metaphyseal fractures, 20 of whom (69 percent) were one year old or younger. The average age of the patients—14 males and 6 females—was 6 months and 10 days.

Each institution used Suspected Child Abuse or Neglect (SCAN) protocols to evaluate all radiographs, mechanisms of injury and associated injuries of the 20 patients at the time of injury assessment. The database analysis showed that 10 cases (50 percent) had a confirmed history of abuse, whereas another five cases (25 percent) were suspected of abuse. In all, 15 (75 percent) cases of complete distal femoral metaphyseal fractures indicated child abuse after a SCAN team evaluation at each hospital.

Based on these results, the authors advise a SCAN team evaluation whenever a child less than one year of age with a metaphyseal distal femur fracture is brought to a hospital for treatment.

The lead researcher for poster exhibit P255 is Lawrence Wells, MD, of Philadelphia; additional authors include Jared E Friedman, BA, and Alexandre Arkader, MD, both of Philadelphia, and William C. Warner Jr., MD, from Memphis, Tenn. The authors report no conflicts of interest.

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