D) 21-month-old with history of wrestling with his 4-year-old brother has a mid-shaft femur fracture
The femur is the hardest bone in the body, and femur and humerus fractures are concerning for non-accidental trauma in non-ambulatory children or in cases where the mechanism of injury is relatively minor. Wrestling with a sibling who is also a small child is not a major mechanism of injury, and sibling “blame” is a potential red flag for non-accidental trauma as well. Scenario A likely resulted in a “FOOSH” (fall on an outstretched hand) injury, in which case distal radius fractures are common. Simple linear skull fractures (scenario B) occur both accidentally and non-accidentally, and evaluation relies on assessing the mechanism of injury and whether there are other associated injuries concerning for non-accidental trauma. Scenario C is describing a toddler’s fracture, which commonly presents as refusal to walk and no known history of trauma.
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August 27, 2024 at 8:38 pm
D) 21-month-old with history of wrestling with his 4-year-old brother has a mid-shaft femur fracture
The femur is the hardest bone in the body, and femur and humerus fractures are concerning for non-accidental trauma in non-ambulatory children or in cases where the mechanism of injury is relatively minor. Wrestling with a sibling who is also a small child is not a major mechanism of injury, and sibling “blame” is a potential red flag for non-accidental trauma as well. Scenario A likely resulted in a “FOOSH” (fall on an outstretched hand) injury, in which case distal radius fractures are common. Simple linear skull fractures (scenario B) occur both accidentally and non-accidentally, and evaluation relies on assessing the mechanism of injury and whether there are other associated injuries concerning for non-accidental trauma. Scenario C is describing a toddler’s fracture, which commonly presents as refusal to walk and no known history of trauma.