Controversy exists regarding the appropriate management of closed femoral shaft fractures in children of intermediate ages (6-10 years old). To elucidate national practice patterns and trends in the treatment of these fractures at general hospitals and pediatric hospitals, the Kids' Inpatient Database (KID), a national database containing volumes for all inpatient pediatric admissions in approximately half the U.S. states, was reviewed for the years 1997 and 2000. The frequency of surgical treatment, most commonly consisting of internal fixation, increased significantly over this period, while the frequency of spica casting decreased. This change in practice was significantly greater at pediatric hospitals than general hospitals. The overall cost of treatment and hospital length of stay were significantly less at pediatric hospitals than general hospitals, regardless of treatment modality. These findings may be relevant to the issue of specialization of pediatric orthopaedic trauma care.