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Child Abuse

Accidental Spiral Fracture

08/28/2006

Question:

My 10 month old son was left on the couch by the babysitter while the babysitter was vacuuming. When the baby sitter returned, my son was on the floor crying. The baby sitter later said that my son was not as active after the fall. He was later put into and taken out of a walker 2 times. It was discovered later that he had a spiral fracture in his left femure. 1. Could this fracture have been caused by the fall (he may have had his leg stuck between the pillows on the couch when he fell)? 2. If he only slightly fractured his leg in the fall, could he have damaged it more with the activity during the rest of the day, like being taken in and out of the walker and playing with the other kids?

Answer:

A femur fracture is very unlikely to occur following such a short fall.  Physicians have difficulty being 100% certain when trying to correlate unwitnessed trauma with injury and so giving you an absolute answer is not possible.  However, using "known" data, i.e. injuries resulting from observed short falls and observed falls which resulted in femur fracture, a femur fracture is very unlikely following a fall from a couch.

Fractures can be extended, or further displaced, if left untreated and manipulated.  Whether this might have occurred with your son could be better explained by your treating physician.

Femur fractures are often painful.  The timing of his injury might be related to when he became less active or irritable. 

It would be very reasonable to question the history above.  More than likely, there is another explanation for this fracture. 

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Response by:

Robert Shapiro, MD
Professor of Clinical Pediatrics
College of Medicine
University of Cincinnati