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Femur fracture in infants: a possible accidental etiology
Insights
Femoral fractures in infants can occur from playing in an Exersaucer, not just abuse. This challenges the typical investigation of such injuries, suggesting a need to consider product-related trauma.
Area of Science:
- Pediatric orthopedics
- Child abuse and neglect
- Biomechanical engineering
Background:
- Femoral fractures in nonambulatory infants are often presumed to be abusive injuries.
- Investigations typically involve social services, law enforcement, and legal proceedings.
- This presumption can lead to significant family distress and legal complications.
Observation:
- Two cases of nonambulatory infants with identical oblique distal femoral metaphyseal fractures are presented.
- These fractures occurred after the infants played in an infant stationary activity center (Exersaucer).
- The fractures extended through the growth plate, a pattern sometimes associated with significant force.
Findings:
- The specific fracture pattern observed in both infants was consistent with forces generated by the Exersaucer's twisting motion.
- This suggests a potential mechanism for accidental injury in this device.
- The findings challenge the automatic attribution of such fractures to abuse.
Implications:
- Healthcare providers should consider the possibility of accidental injury from infant activity centers when evaluating femoral fractures.
- This may alter the standard investigation protocols for suspected child abuse in these specific cases.
- Further biomechanical studies are warranted to confirm the forces generated by infant activity centers and their potential to cause fractures.
Abstract:
Femoral fractures in nonambulating infants are generally felt to be attributable to abuse in the absence of significant trauma or underlying organic pathology. The investigation of such fractures includes a report to appropriate social service and law enforcement agencies, and legal involvement. This paper describes 2 nonambulatory infants who sustained identical oblique distal femoral metaphyseal fractures extending through the growth plate after playing in an infant stationary activity center called an Exersaucer. It is possible that the twisting motion provided by the Exersaucer (Evenflo, Picqua, OH) might be consistent with the generation of forces necessary to cause these fractures.