The causative factor responsible for producing a femoral fracture was determined in 74 children 5 years of age or younger admitted to Oklahoma Children's Memorial Hospital over a 5-year period. Almost one-half of the fractures (34/74) were sustained as a result of suspected or confirmed abuse: most (17/26) of the fractures in infants less than 1 year of age were a result of abuse. Seven automobile-pedestrian accidents were causative in children 2 years or older. An accurate history, good record keeping, common sense, and awareness of the incidence of abuse will assist the orthopedist in recognizing abuse when it is likely, and sparing the family when it is not.