When to Suspect Abuse in Children with Fractures

Deciding whether to initiate an investigation for suspected child abuse can be difficult. Underreporting might expose children to greater injury, but investigations disrupt families, regardless of the final determination. Researchers systematically reviewed published studies that compared fractures resulting from physical abuse and from other causes in children younger than 18 years. Review articles, consensus statements, expert opinion, and other methodologically weak studies were excluded; 32 studies were included.

Overall, fractures resulting from abuse were most common in infants and toddlers. Among femoral fractures, the mid-shaft of the femur was the most common fracture location in both abused and nonabused children. Metaphyseal femor…