Bilateral Femur Fractures in Children: 14 Years of Experience at a Level I Pediatric Trauma Center

Simultaneous bilateral femur fractures (SBFFs) are an extremely rare type of injury, particularly among pediatric patients. Because of their infrequency, pediatric SBFFs are poorly characterized in the literature. Here, we review our center's experience with managing them. We hypothesized that such injuries were likely to be accompanied by additional traumatic injuries to other organ systems/parts of the body.

This retrospective, observational cohort study was conducted on all patients who underwent treatment for SBFFs at a freestanding, level I pediatric hospital between May 2008 and September 2022. Patients were excluded from the study if they were over age 18 or had bilateral femur fractures that occurred on separate occasions. Demographic data and details related to the patient's presenting injuries, hospital stay, and orthopaedic interventions were collected through chart review. Injury Severity Scores (ISS) were obtained from the trauma registry.

A total of 17 patients were identified, most of whom were male, black, injured in a motor vehicle accident as unrestrained passengers, and had an associated injury to the head or neck at the time of presentation. Median age was 5.65 years (range: 0.93 to 16.84 y) while the median ISS was 14. Nearly half of the patients were admitted or transferred to the intensive care unit during hospitalization. One quarter of the patients required mechanical ventilation during the hospital stay, with 2 patients (12%) developing symptoms concerning for pulmonary fat embolism. No mortalities were observed following treatment of the femur fractures.

To date, this is the largest cohort of pediatric patients with simultaneous bilateral femur fractures that has been examined. More research into this topic should be carried out with larger sample sizes to further characterize the complication profile and long-term outcomes of this injury pattern.

Level III.