Pediatric and adolescent ballistic femur fractures: treatment, outcomes, and costs from a level-one trauma center.

Abstract

Pediatric ballistic femur fractures are severe injuries that require extensive follow-up and have high rates of complication and cost. Treatment strategies are largely derived from adult trauma principles; this study aims to characterize the management, outcomes, and costs of pediatric and adolescent ballistic femur fracture patients presenting to an academic level I trauma center. This retrospective case series gathered data from a single academic level I trauma center. Patients aged 0-21 years who sustained a ballistic femur fracture and presented between 2017 and 2022 were included. Pediatric patients were defined as ≤ 18 years, and adolescents as 19-21 years. Patient demographics, injury characteristics, management details, in-hospital costs, and outcomes were recorded. Subgroup analysis compared pediatric and adolescent cohorts. A total of 34 patients were identified, including 19 pediatric and 15 adolescent patients. Comorbidities were uncommon and non-contributory in both groups. No significant differences were noted between groups with respect to demographics, treatment strategies, outcomes, or complications. Inpatient management was significantly more costly than outpatient management. This series includes a mixture of non-operative, intramedullary nailing, and open reduction internal fixation patients to broadly represent the pediatric ballistic femur fracture population. High union rates, similar time to union, and low complication rates were observed in both pediatric and adolescent cohorts. Subgroup analysis demonstrated no significant differences in outcomes or complications, supporting extrapolation of adult trauma literature to this population. A considerable loss to follow-up was noted, with male sex, lack of insurance, substance use, and non-operative management identified as common risk factors.