PURPOSE OF THE STUDY: The primary aim is to assess the proportion of children younger than two years with a femoral fracture who underwent a skeletal survey. The secondary aim of the study is to evaluate the patients' demographics, reported trauma mechanism, type of fracture, type of treatment and complication rate. MATERIAL AND METHODS This was a retrospective study of children younger than two years examined at the Department of Imaging Methods for a femoral fracture between 2015-2022. The type and site of the fracture were assessed on radiographs. The patients' medical records were used to assess which steps had been taken to evaluate for possible abusive etiology of the fracture. The data were correlated with the published guidelines for performing skeletal survey in young children with fractures. The patients' demographics, medical history, time interval from trauma or symptoms onset to medical examination, type of treatment, duration of orthopaedic follow-up in addition to the clinical fi ndings at the last orthopaedic follow-up visit were also retrieved from the patients' medical records. RESULTS A total of 40 children were included in the study, 21 of whom were girls (52.5%). The mean age was 13.8 months. 5 children (12.5 %) were younger than 6 months. 36 children (90%) had a history of trauma, the vast majority of whom suffered a fall. 21 patients (52.5%) sustained a distal metaphyseal fracture, 19 patients (47.5%) suffered a diaphyseal fracture. A spica cast was used in 12 patients (30%), which was applied under general anaesthesia in most cases. 28 patients (70%) received a long leg cast. A certain degree of stiffness following cast removal was the only documented complication. Based on the published guidelines, it was estimated that in 23 patients (57.5%) a skeletal survey should have been performed. However, this investigation was performed in 2 patients (5%) of the study population only. DISCUSSION Femoral fractures in young children are rare, especially in those younger than six months of age. The fractures were located in femoral diaphysis and in distal femoral metaphysis. Surgical treatment was not required, and no signifi cant complications were observed. Nonetheless, the study showed that the rate of child abuse screening was low. The skeletal survey was performed in two cases only, both children were younger than six months and had no history of trauma. Based on the published guidelines, however, it may be assumed that the skeletal survey should have been performed in more than half of the patients in the study. The failure to perform this investigation might have led to the abuse not being detected and the child being returned to the abusive environment. CONCLUSIONS Management of femoral fractures in patients younger than two years does not usually require hospitalisation and is not associated with the risk of complications. However, potential further harm may be caused if abusive etiology of the femoral fracture fails to be discovered. This study has shown that the rate of abuse evaluation is low. It is essential to initiate a multidisciplinary discussion on this topic to raise the physicians' awareness and to implement the screening for child abuse among young children with femoral fractures. This scientifi c paper also includes a summary of necessary steps to be taken in the evaluation of a young child with a femoral fracture. KEY WORDS: fractures, femur, children, infant, child abuse, radiography.

2 lékařská fakulta Univerzity Karlovy magisterský studijní program Všeobecné lékařství Praha

Klinika dětské a dospělé ortopedie a traumatologie 2 lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole Praha

Klinika zobrazovacích metod 2 lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole Praha

Femoral Fractures in Children Younger than Two Years. Are We Considering Abusive Etiology?