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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.