Incidence and Healthcare Structure of Pediatric Femoral Shaft Fractures in Germany

Background: Femoral shaft fractures in childhood and adolescence are rare but serious injuries. The aim of the present study is to investigate the incidence and care structure of femoral shaft fractures in childhood and adolescence based on the complete hospital case data in Germany. Materials and Methods: For this retrospective, controlled registry study, the hospital case data of the Institute for the Hospital Remuneration System (InEK) for all patients treated as inpatients in Germany from 01/2019 to 09/2024 were evaluated. In addition to demographic data, the principal diagnoses, all secondary diagnoses, all billed procedures and the structural data of the treating hospital were analysed. Inclusion criteria were a femoral shaft fracture as the principal diagnosis and age between 3 and 17 years. Patients were assigned to the age groups 3-9 years (I), 10-15 years (II) and 16-17 years (III). Results: The study analyses the inpatient treatment data of 7234 patients with the principal diagnosis femoral shaft fracture (S72.3). The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000. The group of 3-9-year-olds was treated predominantly with elastic stable intramedullary nailing (ESIN). In patients older than 15 years, ESIN was no longer used; these patients were predominantly treated with rigid intramedullary nail osteosynthesis. Length of stay increased with age from 3.8 days in group I to 5.8 days in group II and 8.3 days in group III. The majority of patients were treated in hospitals with more than 600 beds. Only 4% of the fractures were open fractures. In 2.7% of cases there was a mechanical complication of the osteosynthesis. 27% of the surgical procedures were implant removals. Discussion and Conclusion: The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000 and shows an age- and sex-dependent pattern. ESIN intramedullary nailing is the most common operative method up to the age of 15 years and is no longer used beyond 16 years.