Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review

INTRODUCTION: Bilateral femoral diaphyseal fractures in children due to nonaccidental trauma (NAT) are a rare occurrence, with no reported cases currently published in the literature. The authors present a case of an 8-month-old male who presented with bilateral femoral shaft fractures. History, physical examination, and radiographic findings support NAT as the cause of his injuries. Due to the patient’s size and associated comorbidities, he was initially treated with Pavlik harness placement, rather than spica casting. The patient demonstrated appropriate radiographic evidence of fracture healing on follow-up. CASE REPORT: An 8-month-old male with a complex past medical history presents to the emergency department. Per the patient’s mother, he has been demonstrating a progressive loss of movement and refusal to bear weight in his bilateral lower extremities over the preceding 1–2 weeks. Other injuries include facial bruising and lesions indicative of subconjunctival hemorrhages. After orthopedics was consulted, the decision was made to treat the patient’s bilateral femoral shaft fractures with a Pavlik harness, rather than spica casting, due to his small size and associated past medical history. The patient was subsequently discharged under foster care. Follow-up visit demonstrates appropriate fracture healing in the bilateral femoral diaphyses. CONCLUSION: Many cases of NAT in the pediatric population are initially missed. Orthopedic providers must maintain a high index of suspicion for NAT as many of these patients will present with musculoskeletal injuries. The authors report a rare case of NAT in a male child resulting in bilateral femoral diaphyseal fractures. The patient was successfully treated through Pavlik harness placement. Orthopedic providers should consider Pavlik harness placement as a viable option even for young children >6 months of age presenting with femoral shaft fractures if spica casting or open reduction internal fixation is not appropriate.