The Hip: Preservation, Replacement and Revision

Femoral Shaft Frx in Infants: 0 to 2 yrs

- Discussion:
    - child abuse: child abuse occurs in 50-80% of children < 2 yrs w/ femoral frx;
    - limb length inequality are seldom a problem since frx does not shorten excessively;
    - acceptable reduction:
           - in children younger than 2 yrs, shortening of up to 1-1.5 cm & angulation of 30 deg are acceptable;

- Radiographs:    

- Treatment:
    - early spica cast is often possible, if there is an acceptable reduction;
    - w/ an unacceptable reduction, consider a period of skin traction using modified Bryant's traction (thighs in 45 deg flexion and 30 deg abduction);
           - both legs need to be placed in traction to stabilize the pelvis;
           - contraindicated after the age of 2 yrs or w/ weight more than 25 lbs;
           - deligent skin care is a requirement;
    - union occurs in about 2 weeks;
    - leg weakness and/or limp may persist for one year;
    - in the report by Morris S, et al (2002), the authors undertook a study to assess their incidence and outcome;
           - 7 patients from a total of 55,296 live births suffered 8 femoral fractures (incidence 0.13 per 1,000 live births);
           - twin pregnancies, breech presentations, prematurity, and disuse osteoporosis were associated with the occurrence of a fracture;
           - variety of treatment modalities were used, including gallows traction, spica cast, and Pavlik harness;
           - all patients in this study, regardless of treatment, had a satisfactory clinical outcome, with no evidence of limb length discrepancy or angular deformity on follow-up;
           - ref: Birth-associated femoral fractures: incidence and outcome.

Comparison of Pavlik Harness Application and Immediate Spica Casting for Femur Fractures in Infants.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 7, 2012 10:16 am