For children 6 months to 5 years, spica casting (with or without pre-casting traction) has been shown by multiple studies to give good results.(Rasool, 1989 Burton, 1972) In patients 5-11 years of age, femur fractures may be treated with flexible nails, submuscular or open plating, or external fixation. Femur fractures in a child under 6 months are typically well-treated in a Pavlik harness or spica cast. No clear consensus has been reached regarding optimal treatment, despite attempts at the creation of formal guidelines.(Kocher, 2010) There are a number of trendswhich have emerged to help guide management based on the above characteristics. Treatment of femur fractures varies by age, fracture pattern, mechanism, weight of the child, and associated injuries. Open fractures are classified by the system of Gustilo and Anderson.(Gustilo, 1976) Transverse fractures are considered “length-stable” and some oblique or comminuted fractures are considered “length-unstable”. Stability of the fracture influences treatment. Level of the fracture on the femur is important, as displacement of the fracture pieces is characteristic based on the muscle attachment points and the forces applied to the fractured pieces. Fracture patterns include: transverse, short oblique, spiral, and comminuted. Plain radiographs are usually sufficient for establishing the diagnosis and for preoperative planning.įractures are classified by pattern, location, stability, and whether the fractures are open or closed. X-ray evaluation should include the whole femur, as associated injuries such as an ipsilateral physeal fracture about the knee or a femoral neck fracture can occur. Hemodynamic instability and significant drop in hematocrit are rarely present in a child with an isolated femur fracture and should alert the physician to look for associated injuries.(Ciarallo, 1996 Lynch, 1996) However, more subtle findings may be present in the small child. Typical physical exam findings associated with femur fracture include: deformity, thigh swelling, and pain. In the setting of suspected femur fracture, it is critical that the entire child is examined as associated injuries are common. Fifteen percent of femur fractures in children under 2 years and up to 80% of fractures before walking age are the result of non-accidental trauma.(Loder, 2006 Beals, 1983 Blakemore, 1996 Gross, 1983) Transverse fractures may be a better predictor of nonaccidental trauma in young children as compared to spiral fractures.(Murphy, 2015) In younger children, a fall is the most common mechanism. Falls and motor vehicle collisions are the most common mechanisms of injury, accounting for approximately two thirds of the injuries in older children. There is a bimodal age distribution of fractures, first in early childhood then again peaking in adolescence. ![]() Males more commonly sustain femur fractures, as they account for greater than 70% of injuries. Trauma is the leading cause of death and disability in children.(Waller, 1989 Haller, 1983 Peclet, 1990) When evaluated in the late 1990’s, orthopaedic trauma led to 84,000 hospital admissions annually and a cost of nearly a billion dollars.(Galano, 2005) Femur fractures were the most common reason for admission in this group. Surgical treatment has reduced the burden of care for families, shortened hospital stays, and decreased the early disability and disruption in the families’ lives.(Hughes, 1995 Karn, 1986 Kirby, 1981 Buechsenschuetz, 2002) Treatment varies by age, weight, and fracture patternįemoral diaphyseal fractures account for nearly 2 percent of all bony injuries in children, and are the most common orthopedic injury requiring hospitalization.(Sahlin, 1990 McCartney, 1994 Flynn, 2004) In the past, femur fractures in all children were commonly treated with immediate spica casting or a period of traction followed by casting.(Flynn, 2001) Non-surgical treatment with spica casting remains the standard for infants and toddlers less than 5 years however, school-age children are now more commonly undergoing surgical intervention.Adolescents have adult-like mechanism for femur fracture (high energy) and associated injuries are common.Most common femur fracture type in a child is closed, transverse, and non-comminuted.Femur fracture in a child before walking age is suspicious for non-accidental trauma.
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