title: Femoral fractures in children younger than three years: the role of nonaccidental injury.
abstract: BACKGROUND
  Nonaccidental injury (NAI) in children is a major cause of morbidity and mortality, with fractures being the second most common presentation. The presence of a femur fracture has been reported to be suggestive of nonaccidental trauma in 30% to 60% of young children. The purpose of this study was to determine the percentage of NAI in children younger than 3 years presenting with a femur fracture to a single institution within a western Canadian population.
  
  
  METHODS
  A retrospective cohort study was performed for children younger than 3 years who presented to the Alberta Children's Hospital during the years 1994 to 2005. The primary outcome variable was the percentage of NAI associated with femur fracture. Secondary outcome variables included patient demographics, injury characteristics, radiological and other workup, and suspicion of NAI.
  
  
  RESULTS
  The overall percentage of NAI was 11% (14/127 patients) and 17% (10/60 patients) in children younger than 12 months. Age younger than 12 months (P = 0.04), nonambulatory status (P = 0.004), delayed presentation (P = 0.002), mechanism of injury unwitnessed or inconsistent (P = 0.008), and other associated injuries (P = 0.006) were significant risk factors for NAI.
  
  
  CONCLUSIONS
  Children younger than 3 years who present with femoral fracture are at risk for associated NAI, although perhaps this risk is not as high as previously thought. Regardless, a high index of suspicion is mandatory when these children are encountered, and careful screening with a thorough history, physical examination, and other investigations, where indicated, is warranted to rule out associated NAI.
  
  
  METHODS
  Retrospective cohort study, level IV.
authors: Alberta Children's Hospital, Calgary, Alberta, Canada.
authors: Catherine
authors: C
authors: Hui
authors: Elaine
authors: E
authors: Joughin
authors: Simon
authors: S
authors: Goldstein
authors: Neil
authors: N
authors: Cooper
authors: James
authors: J
authors: Harder
authors: Gerhard
authors: G
authors: Kiefer
authors: David
authors: D
authors: Parsons
authors: Jason
authors: J
authors: Howard
mesh_terms: D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment