Authors: Orooj Rahber,  Younis Mortada, Ghazzawi, Mohammed Kamara

Introduction: 

Femoral shaft fractures are the most common injuries treated by orthopaedic surgeons, the  mechanism of fracture is commonly high impact traumas such as motor vehicle collisions in the young (1). A spiral fracture in this territory further reinstates high impact trauma in a twisting motion. In the absence of  such history it is important  for the treating physician to rule out non accidental injury.Wood et al (2) found that mid/proximal diaphyseal fractures were less associated with abuse whereas distal metaphyseal fractures were more associated with abuse. Imaging would be an important modality to identify possible pathological fractures decreasing the likelihood for such injuries to be caused by non-accidental injury. 

Abstract:

The investigation and management  of a spiral fracture in the distal femur  shaft of a child, sustained during minimal to no impact injury with vague history given by the patients’ parents. Initially was suspected to be a non-accidental injury to due nature of fracture and the incongruous mechanism of injury described by the parents; further imaging by X-ray and MRI confirmed the spiral fracture in the distal femur with underlying  fibrous dysplasia ruling out non-accidental injury and swaying management of a pathological fracture in this child. 

Case Presentation:

7 year old child came into the ED with swelling and unable to bear weight on the left side after kicking a football whilst playing in the garden. Following this, the child was in considerable pain and was unable to straighten her knee. 

She had no significant past medical history, no previous safeguarding concerns and was not taking any regular medications. 

Her observations were stable and baseline blood tests were all within normal limits. 

On examination, there was an obvious swelling in the distal femur but no palpable deformity felt on the affected side. She was unable to extend her knee due to pain however the tibia, fibula and knee joint were all intact. The distal pulses were felt and no neurological deficits were present. 

Head to toe examination was unremarkable and no other injuries identified. 

An X-ray of the left femur, knee and pelvis was requested.