Brnjos K, Lyons DK, Hyman MJ, et al. - The present study was conducted to examine the epidemiology of children undergoing these procedures in the United States. Between 2011 and 2017, the Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for patients between the ages of 3 and 6 years undergoing spica casting or elastic stable intramedullary nailing (ESIN) for a diaphyseal femur fracture. Researchers recruited a total of 4,059 individuals, performing spica casting in 2,878 children (71%) and ESIN in 1,181 (29%). In preschool-age children, there is a substantial variation in the chosen treatment for diaphyseal femur fractures in the United States. For older children, ESIN is more likely to be chosen. The data demonstrate that it is also most likely to be conducted in the Midwest and least likely in the Northeast. These observations may have implications in terms of cost and resource utilization and imply the need for more clinical data to guide surgical indications.