A 4 year old female brought to casualty depament with multiple fracture ribs, and inconspicuous history from parents. On examination show multiple bruise and healed fractures. The provable diagnosis is:

D i.e. Battered baby syndrome Faracture Shaft Femur In Children Mechanism of Injury Child abuse is the most common cause of femoral fractures before walking age (< 2 years)Q. The factors that should rise suspicion include: - First born child, multiple injuries - Pre existing brain damage - Bilateral fracture, spiral fractureQ - Subtrochanteric or distal metaphyseal beak fractures. - Several fractures in different stages of healingQ - Delay by family in seeking treatment - Associated with bruise, petechiae & echymosisQ. Minor trauma or repietitive fractures indicate the possibility of underlying pathology eg. Osteogenesis imperfecta, aneurysmal bone cyst, non ossifying fibroma and eosinophilic granuloma. Osteogenesis imperfecta is diagnosed by presence of blue scleraQ, hearing loss, multiple fractures in different stages of healing and dentinogenesis imperfecta. Managment Plan Different available modalities of treatment are Pelvic harness (< 6months age) - Gallow traction infants < 12 kgQ of weight. But no more than 2 kg of weight should be used as traction and feet must be frequently checked for circulatory problems, - Russell's traction skeletal traction on Thomas knee splint and skeletal traction with out splint (Perkins traction) are more suitable for older children & adolescents. - Immediate or early spica casting is the treatment of choice in children 6 months to 6 years of age for femoral fractures with < 2 - 3 cm of initial shoening, and stable fracture pattern. - Femoral fractures with > 2- 3 cm of shoening or marked instability (i.e.) high probability of slipping of reduction and tight thigh swelling in 6 months to 6 years age group, who cannot be reduced with immediate spica casting, require 3 - 10 days of skin or skeletal traction before casting. Skeltetal fixation by enders intramedullary flexible rods & plating can be used in children with multiple trauma, head injury, vascular compromise, floating knee injuries or multiple fracture, preferrably in chidren > 6 years of age. It is imoant to understand that enders nail is more useful in stable fracture pattern & plating in unstable fracture pattern. External fixator is used in open fractures (compound injuries)