Non-accidental injury – fractures

Abuse should be considered if:

  • multiple fractures
  • rib fractures (7 in 10 NAI)
  • femoral fracture (see below)
  • Under 3 with humeral fracture (1 in 2 NAI)
  • Mid shaft humeral fracture more frequently NAI, supracondylar less frequently
  • Infant/toddler skull fracture (1 in 3 NAI).  Type and location not helpful

Formerly known as CORE Info, the RCPCH Child Protection Portal hosted on the RCPCH website provides evidence-based guidance for health professionals concerned about non-accidental injury 

  • Fractures in the abuse group occurred predominantly in children less than 1 year of age.
  • Femoral fractures under 1 year of age are significantly associated with abuse.
  • One-third of isolated femoral fractures under 3 years of age were abusive.
  • Abusive femoral fractures occur predominantly in infants (evidence level IIb) [3].
  • Significantly more abusive femoral fractures arise in children who are not yet walking (evidence level IIb) [3].
  • Mid-shaft fractures are the most common fracture in both abuse and non-abuse groups (analysed for all age groups) (evidence level IIa) [3].
  • Under 15 months of age, a spiral fracture is the most common type of abusive femoral fracture p=0.05 (evidence level IIb) 

2014 Systematic review on bites has been withdrawn pending new review – interim advice on RCPCH child protection portal but need to be member.

Rib fractures with callus are at least 2 weeks old.  Other than that, unable to date.

Systematic reviews of various NAI issues at