The femur, the bone between your hip and knee joints, is the longest bone in your skeleton. Femur fractures are common in children under the age of 5 because their bones are quite soft and falls are frequent. Femur fractures in infants, however, pose some nuances that caregivers and parents should be aware of.
Possible Physical Abuse
The greatest consideration of an infant under the age of 12 months with a fractured femur is the possibility of child abuse -- the younger the child, the greater the chance of abuse. A study published in 1991 by Drs. Thomas, Rosenthal, et al., estimated that 30 percent of femur fractures in children less than 4-years of age are due to abuse. The infant should be carefully examined for bruising and other injuries. When a fracture is identified, a skeletal survey, x-rays of their entire skeleton, should be performed to identify other fractures, new or old.
Character of the Fracture
The character of the femur fracture can also be important. Accidental fractures typically cause a fracture straight across or angled across the bone; however, spiral fractures of the femur occur only with a tremendous twisting force and are indicative of abuse in children less than the age of 15 months, reports a study by Drs. Kemp, Dunstan, et al.
Other Causes
Rare causes of fractures in infants are congenital diseases such as Osteogenesis imperfecta, and cysts or tumors that make the bone wall very thin. As infants become more active by rolling, crawling and walking, accidental femur fractures are more likely, with fractures possible even by falling down one step.
Possible Complications
The most common site of a femur fracture is the shaft, the long portion of the bone. Fractures in the growth plates at either end of the shaft can be complicated, and a fracture along the neck of the femur -- the thin stalk that the ball of the hip joint is on -- can be disastrous, causing disruption in the blood supply to the ball which can subsequently die. Eventually, the arthritis from a dead femoral ball will require hip replacement surgery.
Treatment
Absent of complications, an infant with a fractured femur is treated with a "spica" cast, a cast which envelops the child's lower back, abdomen and both legs to below the knee. Infants seem to adapt well to these casts, but the most difficult part of caring for a spica cast is diapering the baby. This usually involves a plastic wrap to protect the cast and the cotton gauze under it, and a good deal of imagination on the part of the parents. The cast is usually required for 4 to 6 weeks. Generally, the fractures heal with no problems, and the infants catch up with their motor development within a matter of months.
References
- "British Medical Journal," Patterns of Skeletal Fractures in Child Abuse: Systematic Review, AM Kemp, F Dunstan, et. al., 2008
- "Pediatrics," Long-bone fractures in young 2. children: distinguishing accidental injuries from child abuse., SA Thomas, NS Rosenthal, et. al., 1991
- "Medscape General Medicine," Pediatric Femoral Shaft Fractures, BE Hakala, JS Blanco, 2000
