• Yaniv Yonai, Merav Ben Natan, Binyamin Finkel, Adi Klein, and Yaron Berkovich.
• From the Orthopedics B Department.
• Pediatr Emerg Care. 2022 Nov 1; 38 (11): 613-616.

ObjectivesThis article explores factors associated with referral of children with a femur fracture to a social worker by an orthopedist for suspected child abuse.MethodsThis retrospective chart review study included 131 children younger than 5 years who sustained a femur fracture and were hospitalized in a major 495-bed hospital located in the northern-central Israel from 2009 to 2021. Data on children who were referred to a social worker by the treating orthopedist and those who were not were compared.ResultsMore than half the children studied (58.8%, n = 77) were referred to a social worker by an orthopedist for suspected child abuse. However, only a fifth of these cases were eventually reported to the authorities. Male sex (odds ratio [OR], 2.44), younger age of the child (OR, 0.95), and spiral femur fracture type (OR, 5.30) increased the likelihood of referral. In addition, treatment of the child by an orthopedic specialist (as compared with an orthopedic resident; OR, 3.12) and lengthier professional experience of the treating orthopedist (OR, 1.08) increased the likelihood of referral.ConclusionsYounger male children presenting with a spiral femur fracture have a higher likelihood to be referred to a social worker because of suspected child abuse by treating orthopedic specialists with lengthier professional experience. The findings point to the need to improve the capacity of orthopedic residents to report child abuse.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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