Improved Treatment of Femoral Shaft Fractures in Children

Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

“…Of the articles detailing the use of traction, seven specifically had no traction, 12 , 15 , 23 , 25 , 27 , 61 , 103 12 used isolated skin traction, 20 – 22 , 35 , 36 , 46 , 48 , 53 , 59 , 62 , 68 , 76 and 19 used skeletal traction on some, if not all, of their patients via a Kirschner wire applied to either the distal femur, 10 , 18 , 19 , 24 , 33 , 38 , 41 , 57 , 64 , 67 , 72 , 80 , 94 proximal tibia 13 , 26 , 45 , 97 or unspecified pin location. 52 , 82 Eight retrospective reviews had patients within their cohorts who had received either skin traction or skeletal traction, 17 , 34 , 40 , 56 , 64 , 82 , 86 , 102 but no direct comparison was made between these two treatment options. Overall, in the last ten years, authors have preferred either no traction or skeletal traction, with only three articles 21 , 62 , 68 explicitly using skin traction.…”

Immediate Incorporated Hip Spica Casting in Pediatric Femoral Fractures

“…17,18 Despite the reduction in cost of treatment and good clinical outcomes with immediate spica casting, angulations and shortening that exceed tolerable limits still continue to be a problem. 11 Of these, 90-90 spica casting is one of the most commonly used methods, but Mubarak et al 20 reported 9 patients who developed leg compartment syndromes, Volkmann contracture, and ankle skin loss. Some examples include 90-90 spica casting, 10 4-corner molding of the cast in the supracondylar region, 5 incorporating the cast with a distal metaphysial pin, 19 and the pontoon technique.…”

“…Operative treatment was increasingly preferred to nonoperative treatment in patients older than 6 years. 11 Buehler et al 8 described the so-called telescope test to identify patients with high risk for unacceptable shortening during immediate spica casting. Dameron and Thompson 2 reported the use of immediate spica cast, and this method yielded excellent results with greatly reduced costs in many series.…”

Femur

“…413,425,515,572,587 I prefer the distal femoral pin, as it avoids risk to the tibial tuberosity with premature growth arrest (Figs. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

“…Furthermore, patients treated with 90°-90°traction and a proximal tibial traction pin may exhibit knee subluxation or dislocation, genu recurvatum, progressive knee pain, and prolonged rehabilitation. 572 Bjerkreim and Benum reported seven cases of genu recurvatum after tibial traction for femoral shaft fracture. Six of the patients eventually required corrective osteotomy.…”