Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Abstract

Purpose Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. Methods This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. ResultsThe type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. Conclusion An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.

Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator

“…Several interventions have been reported for the treatment of length-unstable femoral shaft fracture in children, including traction, followed by spica casting, ESIN, plating, rigid nailing, and external fixator with various constructs ( 15 ). Spica casting following traction requires prolonged hospital stay and demonstrates limited ability of restoring the limb length.…”

Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures

“…Femoral shaft fractures are the most common pediatric lower extremity fracture and the leading cause among pediatric orthopedic injuries that require hospitalization [1,2]. The incidence of pediatric femoral shaft fractures in the United States is estimated to be 20 per 100,000 children per year [1,[3][4][5][6].…”

“…The mechanisms of injury leading to a femoral shaft fracture vary based on the patient's age. Falls are the most common mechanism for children under the age of six, while high-impact sports, motor vehicle-pedestrian accidents, and motor vehicle accidents are more common among preadolescents and adolescents [1][2][3]. Hunter et al found that black males between the ages of 14 and 17 years were at the highest risk for femoral shaft fractures.…”

“…Many studies have evaluated various treatment modalities for pediatric femoral shaft fractures and have created evidence-based treatment algorithms [2,[7][8][9]. Management depends on the patient's age, weight, fracture pattern, mobility, possible complications, and surgeon expertise [2,7].…”

Study to determine the Results of Femoral Shaft Fractures among Children managed with Immediate Hip Spica Cast

“…The femoral shaft fractures treatment varies according to the size and age of the children, the associated injuries and local practice (Prajapati et al, 2019;Mehmood et al, 2019). Contemporary methods of treating femoral shaft fractures comprise many forms of traction, prompt and delayed spica casting, lexible nailing, plate ixation, external ixation and traditional intramedullary nailing for adolescents and older children (Liau et al, 2020;Saeed, 2019). The use of surgical methods is limited by complications such as infections and joint injuries.…”