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Treatment of Closed Femoral Shaft Fractures in Children Aged 6 to 10

Sigrist, Emmalynn J., DO*; George, Nicole E., DO; Koder, Adrienne M., DO*; Gwam, Chukwuweike U., MD; Etcheson, Jennifer I., MD, MS§; Herman, Martin J., MD

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p e355–e359
doi: 10.1097/BPO.0000000000001310

Background: Management of pediatric femoral shaft fractures remains controversial, particularly in children between the ages of 6 and 10. In the current push toward cost containment, hospital type, and surgeon subspecialization have emerged as important factors influencing this treatment decision. Thus, in the present study, we use a nationwide pediatric inpatient database to compare the: (a) incidence; (b) demographic characteristics; (c) hospital costs; (d) length of stay; and (e) treatment method of pediatric closed femoral shaft fractures admitted to general versus children’s hospitals.

Methods: The Kids’ Inpatient Database (KID) was queried for all patients aged 6 to 10 who sustained a closed femoral shaft fracture in 2009 or 2012, and patient records were stratified into children’s hospitals and general hospitals. Primary outcome measures included method of treatment, total hospital costs, and length of stay. Student/Welch t testing and χ2 analysis were utilized to compare continuous and categorical outcomes, respectively, between hospital types.

Results: The total incidence of closed femoral shaft fractures decreased between 2009 and 2012 (1919 to 1581 patients; P=0.020), as did the proportion of patients treated in children’s hospitals (58.6% to 32.3%; P<0.001). In addition, patients treated at general hospitals were more likely to receive open reduction with internal fixation (45.3% vs. 41.1%) or external fixation (4.1% vs. 2.3%), and less likely to be managed with closed reduction with internal fixation (32.0% vs. 39.7%) than those treated at children’s hospitals (P<0.001 for all).

Conclusions: The present study demonstrates a decrease in the incidence of closed femoral shaft fractures in 6- to 10-year old patients from 2009 to 2012, as well as decreased definitive management in children’s hospitals and increased selection of operative treatment. In addition, treatment in a nonchildren’s hospital was associated with decreased total inpatient costs and decreased treatment with closed reduction with internal fixation in favor of open reduction with internal fixation. Future studies should seek to identify the specific surgical procedures performed and match patients more closely based specific fracture pattern.

Level of Evidence: Prognostic level II.

*Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine

Department of Orthopaedic Surgery, St. Christopher’s Hospital for Children, Philadelphia, PA

Department of Graduate Medical Education, Aultman Hospital, Canton, OH

Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC

§Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD

The authors declare no conflicts of interest.

Reprints: Nicole E. George, DO, Department of Graduate Medical Education, Aultman Hospital, 2600 Sixth Street SW, Canton, OH 44710. E-mail:

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