From the Guidelines
Femur fractures in non-ambulatory children and spiral or transverse fractures of the tibia or fibula in young children who cannot provide a plausible explanation for their injury are highly suspicious for child abuse. According to the most recent and highest quality study 1, skeletal surveys should be performed to evaluate for occult or healing fractures when there is concern for abuse and should be performed in those less than 2 years of age.
Key Fractures Indicative of Abuse
- Femur fractures in children who are not yet walking
- Spiral or transverse fractures of the tibia or fibula in young children who cannot provide a plausible explanation for their injury
- Multiple fractures at different stages of healing
- Metaphyseal corner fractures (also called "bucket handle" or "corner" fractures)
- Bilateral fractures without a history of significant trauma These fractures often indicate twisting, pulling, or shaking forces that are inconsistent with typical childhood accidents, as noted in 1.
Evaluation and Imaging
When evaluating a child with these fractures, healthcare providers should conduct a thorough skeletal survey, especially in children under 2 years, and consider additional imaging such as a follow-up skeletal survey in 2 weeks to identify fractures at different healing stages, as recommended in 1 and 1. The child's developmental capabilities should be considered in relation to the reported mechanism of injury, as fractures inconsistent with the child's mobility skills strongly suggest abuse.
From the Research
Leg Bone Fractures Indicative of Abuse in Children
There are no research papers provided that directly address which leg bone fractures are indicative of abuse in children. The studies provided focus on the treatment and management of tibial shaft fractures, proximal tibia fractures, and complex tibial plateau fractures in adults, as well as the comparison of external fixation and open reduction and internal fixation in the treatment of these fractures.
Types of Fractures and Treatment Options
- Tibial shaft fractures can be treated conservatively or operatively, depending on the severity of the fracture and the patient's overall health 2.
- Proximal tibia fractures can be treated with external fixation, intramedullary nailing, or plating, depending on the severity of the fracture and the patient's overall health 3.
- Complex tibial plateau fractures can be treated with external fixation or open reduction and internal fixation, with external fixation providing better functional outcomes and range of motion in some cases 4.
Associated Injuries and Complications
- Patients with tibia/fibula fractures are at a higher risk of associated torso, severe head, and severe spine injuries compared to patients with femur fractures 5.
- External fixation and open reduction and internal fixation are associated with different complications, including infection, malunion, and fixation failure 6, 4.