Patient Presentation
A 6-month-old female was transferred to the emergency room of a children's hospital for treatment of a femur fracture. Her mother was carrying her down some stairs and fell landing on the infant. The mother could not give more details of how she was carrying the infant before the fall, how many stairs she fell down, nor the final position of the infant or herself. The past medical history showed her to be a full-term infant who had received regular health supervision visits. The family history was negative for genetic or skeletal disease. The social history showed two other siblings living with their biological mother and father who are not married. The mother denies any history of alcohol, drugs or violence. The review of systems was negative. The pertinent physical exam showed an alert infant in a leg immobilizer who smiles. Vital signs were normal. Head circumference was 25%, weight and length could not be done accurately due to the immobilizer. She appeared developmentally appropriate. Her examination was normal including head, eyes, abdomen, genitalia and skin. The radiologic evaluation on the radiographs from the outside hospital showed a transverse femur fracture of the diaphysis that was angulated but not shortened. The diagnosis of a transverse femur fracture was made. The patient's clinical course was that she was taken to the operating room where a spica cast was placed. The following day, an evaluation for possible child abuse was conducted and showed a normal head computed tomography examination, normal skeletal survey, normal ophthalmological evaluation and initial screening laboratories were negative. The Department of Human Resources was contacted and discharged the infant to a temporary foster care placement along with her siblings. The Department of Human Resources and the courts determined after further investigation that she had been abused. She was later placed in permanent foster care and was awaiting adoption. Her femur fracture healed with no residual problems.

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