Epidemiology and management of pediatric femoral fractures at a level I trauma center: a 10-year retrospective monocentric study

PURPOSE: Pediatric femoral fractures are relatively uncommon but represent severe injuries frequently requiring inpatient trauma care. Epidemiological characteristics, fracture patterns, and treatment strategies vary between institutions and regions. This study aimed to analyze the epidemiology, fracture distribution, treatment modalities, complications, and fracture-predisposing comorbidities of pediatric femoral fractures treated at a German level I pediatric trauma center over a 10-year period. METHODS: All patients aged 0-14 years treated for femoral fractures between January 2012 and December 2021 were retrospectively reviewed. Fractures were categorized using the AO Pediatric Comprehensive Classification of Long-Bone Fractures (PCCF). Demographic variables, fracture characteristics, management approaches, time to consolidation, complications, and relevant comorbidities predisposing to fracture were analysed descriptively in accordance with STROBE recommendations. RESULTS: A total of 183 patients met the inclusion criteria (67.2% male; mean age 5.2 years). Children aged 2-5 years constituted the largest group (42.1%). Femoral shaft fractures were the most frequent femoral fracture type (70%). Surgical management, most frequently elastic stable intramedullary nailing (ESIN), was increasingly utilized with advancing age. The overall complication rate was 14.2%, with the majority classified as minor. Comorbid conditions predisposing to fracture were present in 22% of patients. CONCLUSION: Femoral shaft fractures represented the predominant femoral fracture type in this trauma-center cohort, particularly affecting boys in early childhood. Surgical stabilization represents an integral component of contemporary pediatric trauma care and was associated with acceptable, predominantly minor complication rates. This study contributes contemporary real-world epidemiological data from a level I pediatric trauma reference center and highlights relevant age-dependent treatment trends and clinical outcomes.