الفهرس 
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Abstract
A femoral shaft fracture is the most common major pediatric orthopaedic injury that most orthopaedists will treat routinely and is the most common pediatric orthopaedic injury requiring hospitalization. Fractures are more common in boys (2.6:1), and occur in an interesting bimodal distribution with a peak during the toddler years (usually from simple falls) and then again in early adolescence (usually from higher-energy injury).
Over the past 20 years, however, there has been a dramatic and sustained trend towards the operative stabilization of femoral shaft fractures in school-aged children using flexible intramedullary nails, external fixation, locked intramedullary nails, and more recently, submuscular bridging plates. These advances have decreased the substantial early disability for the children, as well as the family’s burden of care during the recovery period.
The causes of fractures of the femoral shaft vary depending on the age of the child; in children who have not begun walking, as many as 80% of fractures may be caused by abuse, and in ambulatory children as many as 30% of abuse cases have been reported. As the child matures skeletally the weaker woven bone is replaced by stronger lamellar bone, and a much greater force is required to cause a fracture. Fractures in children over 6 years are largely due to high-energy trauma, with motor vehicle accidents accounting for more than 90% of injuries in this age group.
The incidence of femoral shaft fractures in older children appears to be on the rise because of the increased popularity of other high-speed recreational devices and activities.
Clearly, abuse in the infant population must be ruled out. In older children, a systematic review and thorough primary and secondary survey of the child are critical to the exclusion of associated injuries, given the likelihood of a high-energy mechanism leading to fracture.