Causes / typical injury mechanism: Pediatric patients experiencing a femoral shaft fracture will typically present after experiencing trauma to the affected leg. These fractures can arise through several injury mechanisms. Falls are a frequent cause of femoral shaft fractures. Additionally, blunt trauma to the leg can cause this injury, including crush injuries, sports injuries, and injuries involving a motor vehicle, either as a passenger in the vehicle or by being struck by the vehicle. Typically, injuries in adolescents tend to be higher energy and often involve a motor vehicle. These fractures can also be pathologic (caused by a tumor).
Child abuse should also be considered as a mechanism for femoral shaft fracture. It is estimated that 12%-14% of pediatric femoral shaft fractures in children younger than 3 years are caused by nonaccidental trauma, as well as 30% of cases in patients younger than 1 year.
Classic history and presentation: After this trauma, the patient will experience significant pain, swelling of the affected thigh area, and inability to bear weight. Upon examination, the physician will often note deformity of the affected leg with crepitus when palpating. Patients with an underlying bone pathology, such as infection or a destructive tumor, are at higher risk for presenting with this injury.
Prevalence: Femoral shaft fractures constitute about 1.6% of all pediatric fractures.
- Age – This injury has a bimodal pediatric age distribution, frequently presenting in toddlers and adolescents.
- Sex / gender – Males more commonly present with these fractures than females.
Grade / classification system: There is no formal classification, but these injuries are described by location and fracture pattern. Location of the fracture is often described as proximal third, middle third, and distal third. Fracture patterns can be described as spiral, oblique, transverse, or multifragmentary. It should be noted if the fracture is open or closed.
