Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Femoral shaft fractures in children

Kimberly P Stone, MD, MS, MA
Klane White, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


Fractures of the femoral shaft are common childhood injuries and among the most common causes of hospitalization for pediatric orthopedic injuries. The strong blood supply of the femoral shaft allows for rapid healing and generally favorable outcomes. The treatment for femoral shaft fractures varies based upon the child's age and injury with a trend towards operative stabilization.

Femoral shaft fractures in pediatric patients are discussed here. Proximal and distal femur fractures in children are reviewed separately. (See "Hip fractures in children" and "Distal femoral fractures in children".)


Femoral shaft fractures are among the most common diaphyseal fractures in children with an estimated annual incidence of 19 fractures per 100,000 children in the United States [1-4]. They are also the most common pediatric fracture of the femur, accounting for up to 62 percent of all femur fractures [3].

Several observational studies have identified a bimodal age distribution for femoral shaft fractures with peaks in the toddler age group, where falls are the predominant cause of injury, and in the adolescent age group, where motor vehicle collisions cause most of the fractures [2-5]. Across all age groups, boys have higher rates of femoral shaft fractures than girls [2-8].

Mortality from a femur fracture has been estimated at 1 per 600 patients [5], but is most often due to associated injuries sustained as a result of high energy trauma [3].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Hunter JB. Femoral shaft fractures in children. Injury 2005; 36 Suppl 1:A86.
  2. Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 2006; 26:561.
  3. Rewers A, Hedegaard H, Lezotte D, et al. Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study. Pediatrics 2005; 115:e543.
  4. Hinton RY, Lincoln A, Crockett MM, et al. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am 1999; 81:500.
  5. Galano GJ, Vitale MA, Kessler MW, et al. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 2005; 25:39.
  6. Buess E, Kaelin A. One hundred pediatric femoral fractures: epidemiology, treatment attitudes, and early complications. J Pediatr Orthop B 1998; 7:186.
  7. Hedlund R, Lindgren U. The incidence of femoral shaft fractures in children and adolescents. J Pediatr Orthop 1986; 6:47.
  8. Schwend RM, Werth C, Johnston A. Femur shaft fractures in toddlers and young children: rarely from child abuse. J Pediatr Orthop 2000; 20:475.
  9. Herring JA. Tachdijan's Pediatric Orthopaedics, 4th, Saunders, Philadelphia 2007. Vol 3.
  10. Lynch JM, Gardner MJ, Gains B. Hemodynamic significance of pediatric femur fractures. J Pediatr Surg 1996; 31:1358.
  11. Unal VS, Gulcek M, Unveren Z, et al. Blood loss evaluation in children under the age of 11 with femoral shaft fractures patients with isolated versus multiple injuries. J Trauma 2006; 60:224.
  12. Ciarallo L, Fleisher G. Femoral fractures: are children at risk for significant blood loss? Pediatr Emerg Care 1996; 12:343.
  13. Pierce MC, Bertocci GE, Janosky JE, et al. Femur fractures resulting from stair falls among children: an injury plausibility model. Pediatrics 2005; 115:1712.
  14. Blakemore LC, Loder RT, Hensinger RN. Role of intentional abuse in children 1 to 5 years old with isolated femoral shaft fractures. J Pediatr Orthop 1996; 16:585.
  15. Beaty JH. Fractures of the hip in children. Orthop Clin North Am 2006; 37:223.
  16. Bucholz RW, Heckman JD, Court-Brown C. Rockwood and Green's Fractures in Adults, 6th, Lippincott Williams & Wilkins, Philadelphia 2005.
  17. Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review of 2422 cases. J Orthop Trauma 2006; 20:648.
  18. Kocher MS, Sink EL, Blasier RD, et al. Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg 2009; 17:718.
  19. Buehler KC, Thompson JD, Sponseller PD, et al. A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children. J Pediatr Orthop 1995; 15:30.
  20. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: effects of spica cast treatment on family and community. J Pediatr Orthop 1995; 15:457.
  21. Bopst L, Reinberg O, Lutz N. Femur fracture in preschool children: experience with flexible intramedullary nailing in 72 children. J Pediatr Orthop 2007; 27:299.
  22. Stannard JP, Christensen KP, Wilkins KE. Femur fractures in infants: a new therapeutic approach. J Pediatr Orthop 1995; 15:461.
  23. Podeszwa DA, Mooney JF 3rd, Cramer KE, Mendelow MJ. Comparison of Pavlik harness application and immediate spica casting for femur fractures in infants. J Pediatr Orthop 2004; 24:460.
  24. Irani RN, Nicholson JT, Chung SM. Long-term results in the treatment of femoral-shaft fractures in young children by immediate spica immobilization. J Bone Joint Surg Am 1976; 58:945.
  25. Ferguson J, Nicol RO. Early spica treatment of pediatric femoral shaft fractures. J Pediatr Orthop 2000; 20:189.
  26. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br 1997; 79:975.
  27. Flynn JM, Hresko T, Reynolds RA, et al. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 2001; 21:4.
  28. Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. Am J Orthop (Belle Mead NJ) 2002; 31:71.
  29. Flynn JM, Luedtke LM, Ganley TJ, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 2004; 86-A:770.
  30. Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 2006; 26:497.
  31. Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop 2005; 25:577.
  32. Hedequist D, Bishop J, Hresko T. Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 2008; 28:6.
  33. Moroz LA, Launay F, Kocher MS, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg Br 2006; 88:1361.
  34. Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN. Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter. J Trauma 2006; 60:217.
  35. Malkawi H, Shannak A, Hadidi S. Remodeling after femoral shaft fractures in children treated by the modified blount method. J Pediatr Orthop 1986; 6:421.
  36. Davids JR. Rotational deformity and remodeling after fracture of the femur in children. Clin Orthop Relat Res 1994; :27.
  37. Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop 1992; 12:157.
  38. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop 1997; 17:342.
  39. Carmichael KD, Bynum J, Goucher N. Rates of refracture associated with external fixation in pediatric femur fractures. Am J Orthop (Belle Mead NJ) 2005; 34:439.
  40. Wright JG, Wang EE, Owen JL, et al. Treatments for paediatric femoral fractures: a randomised trial. Lancet 2005; 365:1153.
  41. Kluger Y, Gonze MD, Paul DB, et al. Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma 1994; 36:222.
  42. Canale ST, Puhl J, Watson FM, Gillespie R. Acute osteomyelitis following closed fractures. Report of three cases. J Bone Joint Surg Am 1975; 57:415.
  43. Wallace ME, Hoffman EB. Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg Br 1992; 74:765.
  44. Staheli LT. Femoral and tibial growth following femoral shaft fracture in childhood. Clin Orthop Relat Res 1967; 55:159.
  45. Beaty JH, Austin SM, Warner WC, et al. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop 1994; 14:178.
  46. TRUETA J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br 1957; 39-B:358.
  47. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 2004; 24:363.