Early Institutional Experience With the Dynamic Femur Fracture (DF2) Brace for Pediatric Femoral Fractures: An Institutional Case Series

Traditional spica casting is the standard treatment for pediatric femoral fractures in children under five years of age, but it carries well-documented limitations, including the need for general anesthesia, increased caregiver burden, and high rates of skin complications. Prefabricated functional bracing, such as the Dynamic Femur Fracture (DF2) brace (OrthoPediatrics, Warsaw, IN), has emerged as an alternative that eliminates anesthesia exposure and improves patient mobility. However, clinical data regarding the practical limitations, complication profiles, and patient selection boundaries during early adoption remain limited. This case series describes our institution's early experience with the DF2 brace to provide practical insights into patient selection and brace management. Following Institutional Review Board (IRB) approval, a case series was conducted at a single tertiary care pediatric institution. Records were reviewed for patients aged under 18 years diagnosed with a fracture requiring functional bracing treatment between January 1, 2020, and October 17, 2025. Patients were excluded if they had inadequate clinical and radiographic follow-up of less than six weeks. Demographic variables, injury characteristics, treatment parameters, radiographic time to union, and soft-tissue complications were extracted from electronic medical records into a secure database. Five pediatric patients were evaluated (four traumatic fractures and one elective postoperative reconstruction). Successful fracture healing and a return to age-appropriate activity were achieved in all four traumatic fracture cases. Open, superficial pressure injuries of the proximal lateral calf occurred in two patients, with both successfully managed in the outpatient clinic setting with local wound care. In an elective hip reconstruction case involving a 12-year-old nonambulatory patient with advanced cerebral palsy, the brace dug deeply into the groin and impinged on a pre-existing vesicostomy site, necessitating discontinuation on postoperative day 1 in favor of a straight knee immobilizer. Ultimately, the DF2 brace serves as an alternative to spica casting for acute, isolated femoral fractures in young children, providing reliable bone healing with simplified hygiene access. However, it did not eliminate the risk of pressure injuries in this series, highlighting the need for vigilant stockinette hygiene and proactive padding.