Incidence of Ipsilateral Femoral Neck and Shaft Fractures in Pediatric and Adolescent Patients

To identify the incidence, patient characteristics, and effectiveness of radiographic screening methods for detecting ipsilateral femoral neck and shaft fractures in pediatric and adolescent trauma patients. Design: Retrospective cohort study. The study was conducted at a tertiary pediatric trauma hospital. Patients under the age of 18 years treated for a femoral shaft fracture between 2004 and 2018 were reviewed. Pathologic (metabolic bone disease or bone lesion), periprosthetic and penetrating traumatic femoral shaft fractures were excluded. Patient demographics, mechanisms of injury, treatment methods, and associated injuries were analyzed. Pre-treatment x-rays and CT scans were reviewed for the identification of ipsilateral femoral neck and shaft fractures. Among 840 pediatric patients included in the study, 4 patients (0.5%) sustained ipsilateral femoral neck and shaft fractures. All of the femoral neck fractures were observed in adolescents (ages 13-17) and involved in high-energy traumas. In adolescents involved in high-energy trauma, the incidence increased to 1.7%. Pre-treatment sensitivity of both x-rays and CT scans was only 50% for the detetion of femoral neck fractures. This study reveals that ipsilateral femoral neck and shaft fractures in pediatric patients are rare, occurring in adolescents involved in high-energy trauma. The findings suggest the need for a selective, rather than routine, use of CT scans based on the patient's age and the mechanism of injury. The use of alternative imaging methods such as MRI should be considered in order to balance diagnostic accuracy while minimizing radiation exposure. Prognostic- Level III. See Instructions for Authors for a complete description of levels of evidence.