Pediatric trauma remains a leading cause of morbidity and mortality of children in the United States and entails exorbitant costs. A 1997 national pediatric inpatient database, the Kids' Inpatient Database, was reviewed for current trauma and practice patterns and was found to contain over 84,000 patients admitted for orthopaedic trauma. These patients accrued an estimated $932.8 million in hospital charges. Femur fracture was the most frequent injury among this patient group (21.7% of orthopaedic trauma), followed by tibia and/or fibula fracture (21.5%), humerus fracture (17.0%), radius and/or ulna fracture (14.8%), and vertebral fracture (5.2%). While the majority of pediatric orthopaedic trauma was treated at non-children's hospitals (70.4%), patients with certain diagnoses such as femur, humerus, vertebral, pelvic, or hand/finger fracture or a back sprain/strain were directed to children's hospitals more frequently compared with the total number of pediatric orthopaedic trauma patients. Practice patterns varied for certain subgroups (eg, femoral shaft fractures) of patients, depending on the type of hospital where the child was treated. Children who sustained a femoral shaft fracture in the 6-to-10-year age group were significantly more likely to receive internal fixation versus casting or traction if they were treated at a children's hospital. Understanding the patterns in which traumatic injuries occur in children is paramount to establishing effective injury prevention, as well as adapting treatment to optimize outcomes.