Femoral neck fracture as an atypical presentation of child abuse.

Femoral neck fractures account for 46% of the proximal femur fractures in children; however, the overall incidence of proximal femur fractures in children is <1%. Pathologic causes for proximal femur fractures include local or global causes of bone weakness, such as metabolic bone conditions or neoplastic causes. Nonpathologic causes of femur fractures are caused almost exclusively by high-energy trauma and are readily identified. Nonaccidental injury leading to femoral neck fracture is unusual and can be challenging to diagnose when the medical history is not forthcoming. Femoral neck fractures in children usually are a consequence of high-energy trauma or less frequently are associated with pathologic conditions. If neither condition is readily identified, the possibility of nonaccidental injury should be considered. This article presents a case of nonaccidental injury with an atypical presentation in a 3-year-old girl with a femoral neck fracture and discusses the diagnostic rationale for a diagnosis of nonaccidental injury. This case report highlights the magnitude of child abuse and its early recognition in the orthopedic community.