- Discussion:
- child abuse: 30% of femoral frx in children < 4 yrs are 2nd to child abuse;
- Over-riding of Fracture Fragments:
- in children between the ages of 2-10 yrs, overgrowth averages 0.9 cm;
- in kids between 2 & 10 yrs, side to side apposition w/ 0.5 to 1 cm overriding is the ideal position;
- in children below ages of 8- 9 yrs, up to 2 cm of bayonet apposition can be accepted with no long-term adverse effects;
- overgrowth usually corrects most of the discrepancy;
- some workers still incorporate a femoral pin in the cast;
- references:
-
Femoral shaft fractures in children: the effect of initial shortening on subsequent limb overgrowth.
-
Fractures of the femoral shaft in children. The overgrowth phenomenon.
- Angulation at Frx Site:
- saggital plane tolerates 20-30 deg angulation (accept less in older child);
- frontal plane tolerates 10-15 deg angulation;
- late angulation is managed w/ wedging of the cast;
- Treatment:
- acceptable reduction:
- in this age group, can be treated w/ early
spica cast unless the frx overrides > 2 cm;
- spica cast is left on for approximately 6-8 weeks;
- unacceptable reduction: (more than 2 cm overriding);
- w/ significant shortening of limb at frx site, consider a period of 90-90 deg skin traction (in younger children) or
distal femoral pin traction (in older children) to maintain adequate limb length until early callus forms,
then apply
spica 1-2 weeks later;
- during the period of traction, the hip usually needs to be flexed upto 90 deg and knee flexed 90 deg
inorder to obtain reduction during early phase of frx healing;
- after frx becomes sticky, less hip and knee flexion may be acceptable;
- need to obtain weekly radiographs to follow frx alignment and length;
- once frx site is less tender and once radiographs show early callus, traction may be discontinued;
- skin traction technique pearls:
- apply moleskin strips or Skin-Trac strips directly to skin;
- use no more than 7 lbs of traction force;
- in some cases, a
distal femoral traction pin may be incorporated into the spica cast (and is left in place for 3 weeks);
-
flexible IM nails:
- references:
-
The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis.
-
Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications.
-
Ender rod fixation of femoral shaft fractures in children.
-
Elastic stable intramedullary nailing of femoral shaft fractures in children.
Management of Closed Femoral Shaft Fractures in Children, Ages 6 to 10: National Practice Patterns and Emerging Trends.
