Child abuse is often called a New Zealand Epidemic in the popular media. It encompasses sexual, physical, emotional, and neglect. As Orthopaedic surgeons, our primary involvement is with the physical side. The diagnosis of a femoral fracture in very young children has been reported as highly suggestive of NAI, with rates ranging from 11% to 60%. The purpose of this study was to determine the characteristics of children presenting to the Starship Hospital who had sustained a femoral fracture as a result of Non-Accidental Injury (NAI). All confirmed cases with concurrent diagnoses of NAI and femoral fracture presenting to the Starship over a ten year period from Jan 1999 to 2009 were reviewed. These patients were then compared with all patients with femoral fracture who were referred to the child protection team and with all patients presenting with traumatic femoral fracture during this period. Cases were examined with regards to demographics, circumstances of injury, comorbidities and fracture characteristics. Compared to all femoral fractures, those as a result of NAI were significantly younger. All were aged 3 years or less, with the majority aged 12 months or less. In this age group, approximately a third of those with femoral fracture had a confirmed diagnosis of NAI. In the NAI group, multiple fractures including bilateral femoral fractures were more common. Prematurity was a common co-morbidity. Approximately half of the patients had been seen in hospital for any reason prior to the index admission. More than half of the cases of confirmed NAI presented primarily to the Orthopaedic service. It is important for Orthopaedic surgeons to be able to identify those children with fractures who may be at risk of NAI. In particular, this includes children under the age of 1 who present with femoral fractures.
Prophylactic pinning of the contralateral hip remains controversial in the management of unilateral SUFE. This paper reviews our experience, with particular reference to the fate of the non-operated hip. We reviewed the charts and radiographs of 218 patients who were admitted to Starship Children’s Hospital between 1988 and 2000 with a diagnosis of SUFE. Of the 211 patients with data sufficient for analysis, 168 (80%) had unilateral hip pinning and 43 (20%) had bilateral pinning. 32.8% of patients with a unilateral slip were subsequently readmitted for pinning of the contralateral hip. The time between the two operations averaged 7.5 months and did not vary with race or gender. European females had an almost 50% readmission rate for pinning of the opposite hip while Maori females had the lowest readmission rate (15%). All European females less than 11.5 years with unilateral slips returned for pinning of the opposite hip. 28 of the initial unilateral hip pinnings were for an unstable SUFE. Only 8 of the 28 patients were readmitted for pinning of the opposite hip, all with stable slips. Only one patient with a stable first slip presented with an unstable second slip. Despite a high incidence of bilateralism, this study shows that it is very uncommon for a patient to present with an unstable second slip. Prophylactic pinning can have complications. We therefore recommend follow-up rather than prophylactic pinning for patients presenting with unilateral SUFE. Caucasian females less than 11.5 years represent a group at high risk of a second slip.
