Clinical predictors of pathological femoral fractures in children: a retrospective comparative study

BACKGROUND: Femoral fractures in children are uncommon and are usually trauma-related; however, some occur secondary to underlying bone pathology. Early differentiation between traumatic and pathological fractures is essential to avoid delayed diagnosis. This study aimed to identify clinical predictors associated with pathological femoral fractures in children. MATERIAL AND METHODS: In this retrospective single-center comparative study, 432 pediatric patients (0-17 years) with femoral fractures were included. These fractures were classified as traumatic (n = 386, 89.4%; treated between 2011 and 2023) or pathological (n = 46, 10.6%; treated between 2002 and 2021) on the basis of radiological findings, advanced imaging, or histopathological confirmation. Demographic, anatomical, and injury-related variables were compared between the two groups using Mann-Whitney U or chi square tests. RESULTS: Patients with pathological fractures tended to be older (10.1 ± 4.3 years versus 8.3 ± 5.9 years, p = 0.090) and age-group distribution differed significantly between the two groups (p < 0.001). Traumatic fractures showed a bimodal age distribution, whereas pathological fractures followed a unimodal pattern. Both groups most commonly sustained diaphyseal fractures (58.7% pathological versus 59.8% traumatic). Low-energy trauma mechanisms were significantly more common in pathological fractures (78.9% versus 49.5%, p = 0.001). CONCLUSIONS: Pathological femoral fractures in children differ from traumatic fractures with respect to age distribution, anatomical location, and injury mechanism. They are more likely to occur following low-energy trauma and demonstrate a different age distribution to traumatic fractures. Careful assessment of patient age, fracture location, and trauma mechanism may aid in the early identification of underlying bone pathology and support appropriate diagnostic evaluation.