111 Femur fractures in children with cancers. What could be the aetiology

Introduction Femur fractures in children are uncommon. Incidence of fractures in leukaemia is about 13.5% and is 6 fold higher than estimate. No prevalence data available on fractures among hospitalized children with cancer. Among the cancer patients femur fractures could be due to various reasons such as non-accidental injuries (NAI), osteoporosis and bone metastasis. We report two patients who had mid shaft femur fractures while receiving chemotherapy as in patients. Case history Case 01, 17 months old girl diagnosed with Ewings sarcoma (EWSR1-FLI1 type-2) and paraplegia. Whilst receiving chemotherapy she was experienced acute swelling of her left thigh and diagnosed with a spiral femur fracture which was unrelated to disease. Case 02, 4 year old boy with adrenal cortical tumour. During his treatment he sustained a spiral fracture of his left femur. Both these children sustained their fracture while inpatient and extensive review excluded a possible safeguarding issues. Discussion Case 01 was non ambulatory and case 02 was ambulatory but less able. In multidisciplinary child protection meeting mechanism of the fracture of case 01 was not clear. Child had a habit of trying to bite her toe. But, mum noted she might have caused this when trying to keep her on her side and child refused/rotated – as she did not feel pain therefore the force is difficult to assess – No ill intention was meant. Case 02, he tried to get down from the bed when he falls which leads to the fracture. The conclusion is that there was no evidence of child abuse. Lack of supervision of caregivers was raised as an issue in both cases. Conclusion Spiral femur fracture in a non-ambulatory child must always raise a concern of NAI. However prevalence of fractures of children with cancers in hospital need more evaluation as those are preventable.