Tag Archives: NAI

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

The Welsh Child Protection Systematic Review Group reviewed femoral fractures in non-accidental injury (NAI). Findings were:

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

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

Systematic reviews of various NAI issues at https://childprotection.rcpch.ac.uk/child-protection-evidence/