CHILD ABUSE AND FEMORAL FRACTURES AT STARSHIP HOSPITAL 1999–2009

Abstract

Child abuse is often called a New Zealand Epidemic in the popular media. It encompasses sexual, physical, emotional, and neglect. As Orthopaedic surgeons, our primary involvement is with the physical side. The diagnosis of a femoral fracture in very young children has been reported as highly suggestive of NAI, with rates ranging from 11% to 60%. The purpose of this study was to determine the characteristics of children presenting to the Starship Hospital who had sustained a femoral fracture as a result of Non-Accidental Injury (NAI).

All confirmed cases with concurrent diagnoses of NAI and femoral fracture presenting to the Starship over a ten year period from Jan 1999 to 2009 were reviewed. These patients were then compared with all patients with femoral fracture who were referred to the child protection team and with all patients presenting with traumatic femoral fracture during this period. Cases were examined with regards to demographics, circumstances of injury, comorbidities and fracture characteristics.

Compared to all femoral fractures, those as a result of NAI were significantly younger. All were aged 3 years or less, with the majority aged 12 months or less. In this age group, approximately a third of those with femoral fracture had a confirmed diagnosis of NAI. In the NAI group, multiple fractures including bilateral femoral fractures were more common. Prematurity was a common co-morbidity. Approximately half of the patients had been seen in hospital for any reason prior to the index admission.

More than half of the cases of confirmed NAI presented primarily to the Orthopaedic service. It is important for Orthopaedic surgeons to be able to identify those children with fractures who may be at risk of NAI. In particular, this includes children under the age of 1 who present with femoral fractures.