- External Fixation
    - ref: External fixation of pediatric femoral fractures.
 
- IM Nailing: (flexible vs rigid)
    - avascular necrosis is a reported complication in young adolescents;
         - consider IM entry point anterior to piriformis fossa;
         - children w/ coxa valga may be at risk for AVN, and it may be difficult to gain entry into the IM canal without damaging the trochanteric physis
    - Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients
    - Impact of Clinical Practice Guideline on the Treatment of Pediatric Femoral Fractures in a Pediatric Hospital

- Traction
    - Femoral Traction Pins
    - from 10 to 15 yrs, consider 90/90 skeletal traction;
    - in this age group, skeletal traction is usually needed to achieve satisfactory alignment and minimize the overiding of the frx fragments
                until callus forms at about 3 weeks;
    - after 3 weeks apply Spica Cast:
    - potenial for shortening is greater in this age group, & further the potential for growth acceleration is much declined;
    - union requires 6 weeks;
    - after age 15 treat like an adult;
    - ref: Skeletal traction for fractures of the femoral shaft in children. A long-term study.

- Anterior Angulation:
    - occurs if femur is not flexed in the Spica Cast:

- Varus Angulation:

- Wedging the Cast:

- Telescoping at the Frx Site:
   - common complication;
   - may be avoided by incorporating femoral traction pin into the spica;