Femur fractures resulting from stair falls among children: an injury plausibility model.
BACKGROUND
Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP).


METHODS
Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries.


RESULTS
Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types.


CONCLUSIONS
This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall-related femur fractures and identifies key characteristics to facilitate decision-making.
Pierce
Mary Clyde
MC
Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. mary.pierce@louisville.edu
Bertocci
Gina E
GE
Janosky
Janine E
JE
Aguel
Fernando
F
Deemer
Ernest
E
Moreland
Morey
M
Boal
Danielle K B
DK
Garcia
Sylvia
S
Herr
Sandra
S
Zuckerbraun
Noel
N
Vogeley
Eva
E
D000058:Accidental Falls; D001696:Biomechanical Phenomena; D017028:Caregivers; D015984:Causality; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003288:Contusions / Q000209:etiology; D008192:Deception; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006620:Hip Fractures / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008487:Medical History Taking; D008962:Models, Theoretical; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology; D010290:Parents; D011446:Prospective Studies; D014466:Ultraviolet Rays