SAQ 177 – Paediatric Trauma – femoral fracture and non-accidental injury

Question 2. femoral fracture and non-accidental injury.

a. X-ray findings

• Spiral fracture of the right femoral midshaft.
• The distal segment is medially angulated by approximately 30 degrees.
• No other acute fracture.
• No fractures of different ages or significant callus.
• No pelvic shielding, allowing assessment for other fractures.

b. Relevant history

• Stated mechanism of injury.
• Collateral history and consistency between accounts.
• Identity of the primary carer at the time of injury.
• Delay between the stated injury and presentation.
• Previous child-protection involvement or children known to be at risk.
• Antenatal, birth, congenital, and developmental history.
• Family circumstances, parental illness, or parental substance use.

c. Examination findings

• Altered GCS or abnormal behaviour.
• Bruising, particularly bruises of different ages.
• Abdominal tenderness.
• Torn frenulum or palatal petechiae.
• Genital trauma.
• Retinal haemorrhage.
• Tympanic membrane bruising.
• Haematuria or developmental delay.