OBJECTIVE:This study aimed to identify the 10 most frequent pediatric orthopaedic injuries requiring hospitalization in the United States, the major causes of these injuries, and their economic burden to health care cost. METHODS:The 2006 Kids' Inpatient Database (KID) (age range, 0-20 years) was used to determine the 10 most frequent pediatric orthopaedic injuries requiring hospitalization. The injuries were identified by ICD-9-CM codes 800.0-999.9 and external cause of injury codes (E-codes). Discharges were weighted to produce national estimates according to average age at admission, hospital charges, and length of stay. RESULTS:The 2 populations accounting for the highest total hospitalization charges (USD) for pediatric orthopaedic injury were young children with femur fractures (11 years of age, 20%, $32 441 per visit) and adolescents with vertebral fractures (17 years of age, 8%, $53 992 per visit). But the most common injuries requiring hospitalization were femur (11 years of age; 20%) and humerus (8 years of age; 18%) fractures. The most costly injuries, vertebral and pelvic injuries, were largely related to motor vehicle accidents (11.7% and 14.4%, respectively). In contrast, humerus and radius fractures had a high rate of playground-related injuries (21.9% and 11.3%, respectively). None of the causes accounted for more than 25% of the total incidence for the 10 most common injuries identified in this study. CONCLUSIONS:Identification of the patients responsible for the majority of the hospitalization charges for pediatric injuries will enable institutions to better plan their budgets on the basis of the local incidence.