We retrospectively evaluated 138 children younger than 3 years with femoral fractures who presented to the emergency departments of three major Michigan hospitals between 1979 and 1983. Patients were classified into one of the following four subgroups based on presenting history: accident (22%), bone pathology (8%), abuse (10%), and uncertain origin (60%). Distribution of common fracture types among the four subgroups was similar. Of the uncertain group, 22 cases of abuse were identified during admission and 7 additional cases were found at a later date. The total number of femoral fractures secondary to abuse was 43 (31%) of 138. Children younger than 3 years presenting with a femoral fracture should evoke a high suspicion for abuse.