Pełna treść
2/2026
vol. 101
Artykuł przeglądowy
Femoral fractures in children - diagnostic approaches, classifications, treatment strategies, and outcomes: a comprehensive review
School of Medicine, University of Split, Split, Croatia
Children’s Hospital Zagreb, Zagreb, Croatia
School of Medicine, University of Zagreb, Zagreb, Croatia
Croatian Academy of Medical Sciences, Zagreb, Croatia
School of Medicine, Catholic University of Croatia, Zagreb, Croatia
Pediatr Pol 2026; 101 (2): 175-187
Data publikacji online: 2026/06/30
Plik artykułu
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