Complications of pediatric femoral shaft and distal physeal fractures.

Fractures of the femoral shaft comprise about 1.6% of all bony injuries in children and are the most common pediatric orthopaedic injury that requires hospitalization. The treatment of femoral fractures in children is largely dependent on the child's age and size and takes into account multiple considerations: the child's weight, associated injuries, the fracture pattern, the mechanism of injury, institutional or surgeons' preferences, and economic and social concerns. In addition, during the past two decades, there has been a dramatic change favoring surgical fixation rather than casting because of the many advantages of fixation, including more rapid mobilization. The goal of treatment should be to ultimately obtain a healed fracture and avoid associated complications, such as nonunion or delayed union, angular or rotational deformity, unequal limb lengths, infection, neurovascular injury, disruption of the growth plate, muscle weakness, and/or compartment syndrome.