Case
Isaac is 8 months old. His parents say that he was walking and tripped on a toy. Since that time, he has been crying and won’t move his right leg. On x-ray, you note a right femur fracture.
In this case, an 8 month old may be pulling to stand, but should not yet be walking. This typically begins around 12 months of age. Most cases of femur fracture in children are due to falls from a height, and few are due to running or playing. A femur fracture from walking and slipping on a toy would be extremely unusual without an underlying condition. If abusive injury is suspected, a skeletal survey should be done at the time of presentation as long as the child is stable. It should also be repeated in 2-3 weeks to evaluate for healing fractures.
Red Flags for Fractures Due to Abuse in Children <1 Year of Age or Non-Mobile |
Red Flags for Fractures from Abuse:
- Children <1 year old with a fracture
- Femur, rib, and metaphyseal fractures in non-mobile children
- Fractures in various stages of healing
- Multiple fractures
- Unusual fractures: scapula, vertebrae, sternum
Additional Red Flags That Should Raise Concern for Abuse:
- No explanation or vague explanation for a serious injury
- Details of story continue to change
- Delay in seeking medical care
Author information
The post PEM Pearls: Red Flags for Child Abuse – Case 2 appeared first on ALiEM.