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Femoral shaft fractures in children

INTRODUCTION

Femoral shaft fractures in pediatric patients are discussed here. Proximal and distal femur fractures
in children are reviewed separately. (See "Hip fractures in children" and "Distal femoral fractures in
children".)

EPIDEMIOLOGY

Femoral shaft fractures are among the most common diaphyseal fractures in children with an
estimated annual incidence of 19 fractures per 100,000 children in the United States [1-4]. They are
also the most common pediatric fracture of the femur, accounting for up to 62 percent of all femur
fractures [3].

Several observational studies have identified a bimodal age distribution for femoral shaft fractures
with peaks in the toddler age group, where falls are the predominant cause of injury, and in the
adolescent age group, where motor vehicle collisions cause most of the fractures [2-5]. Across all age
groups, boys have higher rates of femoral shaft fractures than girls [2-8].

Mortality from a femur fracture has been estimated at 1 per 600 patients [5], but is most often due to
associated injuries sustained as a result of high energy trauma [3].

Among hospitalized pediatric trauma patients, femur fractures are the most common orthopedic
injury with an average length of stay of six days and an average hospital charge of USD $14,790 to
$22,290 [2,5]. Of the closed femur fractures in these study groups, 56 to 70 percent were located in
the femoral shaft [2,5].
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Literature review current through: Jul 2021. | This topic last updated: Feb 10, 2020.

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REFERENCES

1. Hunter JB. Femoral shaft fractures in children. Injury 2005; 36 Suppl 1:A86.

2. Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in
children. J Pediatr Orthop 2006; 26:561.

3. Rewers A, Hedegaard H, Lezotte D, et al. Childhood femur fractures, associated injuries, and
sociodemographic risk factors: a population-based study. Pediatrics 2005; 115:e543.
4. Hinton RY, Lincoln A, Crockett MM, et al. Fractures of the femoral shaft in children. Incidence,
mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am 1999; 81:500.
5. Galano GJ, Vitale MA, Kessler MW, et al. The most frequent traumatic orthopaedic injuries from
a national pediatric inpatient population. J Pediatr Orthop 2005; 25:39.

6. Buess E, Kaelin A. One hundred pediatric femoral fractures: epidemiology, treatment attitudes,
and early complications. J Pediatr Orthop B 1998; 7:186.

7. Hedlund R, Lindgren U. The incidence of femoral shaft fractures in children and adolescents. J
Pediatr Orthop 1986; 6:47.
8. Schwend RM, Werth C, Johnston A. Femur shaft fractures in toddlers and young children: rarely
from child abuse. J Pediatr Orthop 2000; 20:475.
9. Herring JA. Tachdijan's Pediatric Orthopaedics, 4th, Saunders, Philadelphia 2007. Vol 3.
10. Lynch JM, Gardner MJ, Gains B. Hemodynamic significance of pediatric femur fractures. J
Pediatr Surg 1996; 31:1358.

11. Unal VS, Gulcek M, Unveren Z, et al. Blood loss evaluation in children under the age of 11 with
femoral shaft fractures patients with isolated versus multiple injuries. J Trauma 2006; 60:224.
12. Ciarallo L, Fleisher G. Femoral fractures: are children at risk for significant blood loss? Pediatr
Emerg Care 1996; 12:343.
13. Pierce MC, Bertocci GE, Janosky JE, et al. Femur fractures resulting from stair falls among
children: an injury plausibility model. Pediatrics 2005; 115:1712.

14. Capra L, Levin AV, Howard A, Shouldice M. Characteristics of femur fractures in ambulatory
young children. Emerg Med J 2013; 30:749.

15. Blakemore LC, Loder RT, Hensinger RN. Role of intentional abuse in children 1 to 5 years old with
isolated femoral shaft fractures. J Pediatr Orthop 1996; 16:585.
16. Beaty JH. Fractures of the hip in children. Orthop Clin North Am 2006; 37:223.

17. Bucholz RW, Heckman JD, Court-Brown C. Rockwood and Green's Fractures in Adults, 6th, Lippin
cott Williams & Wilkins, Philadelphia 2005.

18. Caldwell L, Chan CM, Sanders JO, Gorczyca JT. Detection of Femoral Neck Fractures in Pediatric
Patients With Femoral Shaft Fractures. J Pediatr Orthop 2017; 37:e164.
19. Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review of 2422
cases. J Orthop Trauma 2006; 20:648.
20. Kocher MS, Sink EL, Blasier RD, et al. Treatment of pediatric diaphyseal femur fractures. J Am
Acad Orthop Surg 2009; 17:718.

21. Buehler KC, Thompson JD, Sponseller PD, et al. A prospective study of early spica casting
outcomes in the treatment of femoral shaft fractures in children. J Pediatr Orthop 1995; 15:30.

22. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: effects of spica cast
treatment on family and community. J Pediatr Orthop 1995; 15:457.
23. Bopst L, Reinberg O, Lutz N. Femur fracture in preschool children: experience with flexible
intramedullary nailing in 72 children. J Pediatr Orthop 2007; 27:299.

24. Stannard JP, Christensen KP, Wilkins KE. Femur fractures in infants: a new therapeutic approach.
J Pediatr Orthop 1995; 15:461.
25. Podeszwa DA, Mooney JF 3rd, Cramer KE, Mendelow MJ. Comparison of Pavlik harness
application and immediate spica casting for femur fractures in infants. J Pediatr Orthop 2004;
24:460.
26. Irani RN, Nicholson JT, Chung SM. Long-term results in the treatment of femoral-shaft fractures
in young children by immediate spica immobilization. J Bone Joint Surg Am 1976; 58:945.

27. Ferguson J, Nicol RO. Early spica treatment of pediatric femoral shaft fractures. J Pediatr Orthop
2000; 20:189.
28. Mubarak SJ, Frick S, Sink E, et al. Volkmann contracture and compartment syndromes after
femur fractures in children treated with 90/90 spica casts. J Pediatr Orthop 2006; 26:567.

29. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft
fractures in children. A prospective, randomised study. J Bone Joint Surg Br 1997; 79:975.

30. Flynn JM, Hresko T, Reynolds RA, et al. Titanium elastic nails for pediatric femur fractures: a
multicenter study of early results with analysis of complications. J Pediatr Orthop 2001; 21:4.
31. Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures:
lessons from the learning curve. Am J Orthop (Belle Mead NJ) 2002; 31:71.

32. Flynn JM, Luedtke LM, Ganley TJ, et al. Comparison of titanium elastic nails with traction and a
spica cast to treat femoral fractures in children. J Bone Joint Surg Am 2004; 86-A:770.

33. Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur
fractures. J Pediatr Orthop 2006; 26:497.

34. Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium
elastic nails: a comparison of fracture types. J Pediatr Orthop 2005; 25:577.

35. Hedequist D, Bishop J, Hresko T. Locking plate fixation for pediatric femur fractures. J Pediatr
Orthop 2008; 28:6.
36. Moroz LA, Launay F, Kocher MS, et al. Titanium elastic nailing of fractures of the femur in
children. Predictors of complications and poor outcome. J Bone Joint Surg Br 2006; 88:1361.

37. Chen LK, Sullivan BT, Sponseller PD. Submuscular plates versus flexible nails in preadolescent
diaphyseal femur fractures. J Child Orthop 2018; 12:488.

38. Weiss JM, Choi P, Ghatan C, et al. Complications with flexible nailing of femur fractures more
than double with child obesity and weight >50 kg. J Child Orthop 2009; 3:53.
39. Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN. Closed, locked intramedullary nailing of
pediatric femoral shaft fractures through the tip of the greater trochanter. J Trauma 2006;
60:217.
40. Malkawi H, Shannak A, Hadidi S. Remodeling after femoral shaft fractures in children treated by
the modified blount method. J Pediatr Orthop 1986; 6:421.

41. Davids JR. Rotational deformity and remodeling after fracture of the femur in children. Clin
Orthop Relat Res 1994; :27.
42. Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop 1992;
12:157.

43. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop
1997; 17:342.

44. Carmichael KD, Bynum J, Goucher N. Rates of refracture associated with external fixation in
pediatric femur fractures. Am J Orthop (Belle Mead NJ) 2005; 34:439.

45. Wright JG, Wang EE, Owen JL, et al. Treatments for paediatric femoral fractures: a randomised
trial. Lancet 2005; 365:1153.
46. Kluger Y, Gonze MD, Paul DB, et al. Blunt vascular injury associated with closed mid-shaft femur
fracture: a plea for concern. J Trauma 1994; 36:222.

47. Canale ST, Puhl J, Watson FM, Gillespie R. Acute osteomyelitis following closed fractures. Report
of three cases. J Bone Joint Surg Am 1975; 57:415.

48. Wallace ME, Hoffman EB. Remodelling of angular deformity after femoral shaft fractures in
children. J Bone Joint Surg Br 1992; 74:765.
49. Staheli LT. Femoral and tibial growth following femoral shaft fracture in childhood. Clin Orthop
Relat Res 1967; 55:159.

50. Beaty JH, Austin SM, Warner WC, et al. Interlocking intramedullary nailing of femoral-shaft
fractures in adolescents: preliminary results and complications. J Pediatr Orthop 1994; 14:178.

51. TRUETA J. The normal vascular anatomy of the human femoral head during growth. J Bone
Joint Surg Br 1957; 39-B:358.

52. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary
nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 2004;
24:363.