Treatment of pediatric closed femoral shaft fractures: A decline in use of external fixators over the last decade

Abstract

Background: Femoral fractures represent 2% of all fractures in children. While external fixation was popular for managing pediatric closed femoral shaft fractures, other methods have recently increased in popularity. The purpose of this study was to analyze trends in the treatment of closed femoral shaft fractures over the past decade and quantify the change in usage of external fixators compared to other treatment methods in the pediatric population. Methods: The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) was utilized to generate the prevalence of closed femoral shaft fractures and treatment (open reduction internal fixation, closed reduction, closed reduction internal fixation, open reduction, and external fixation) from 2000 to 2012. Results: The total number of reported pediatric femoral fractures declined from 10,504 in 2000 to 7,798 in 2012. Male-to-female ratios and mean ages were comparable between years. Overall, treatment with external fixation for closed femoral shaft fractures decreased from 2000 to 2012. There was a decrease in external fixation in each year recorded compared to previously reported years. There were no significant differences in treatment by region or hospital size. However, over the 12-year period, the rate of external fixation declined more rapidly in pediatric hospitals compared to nonpediatric hospitals. Conclusions: Treatment of pediatric closed femoral fractures with external fixation has declined in favor of internal fixation over the past decade across all geographic regions and in both teaching and nonteaching hospitals in the United States. This decline in external fixation occurred more rapidly in pediatric hospitals compared to nonpediatric hospitals. The clinical and financial impact of this change in practice needs further investigation. Level of Evidence: Level III.