Paediatric Femur Fractures

Treatment Options

• Immediate spica
  • < 2 year
• Early Spica
  • Skin traction followed by casting within 24 hours
  • Two part cast, thigh first then corset
  • Indicated
    • < 80 lbs with stable fracture pattern
    • Acceptable Reduction
      • 10 mm shortening
      • < 10 years old
        • 15-20° varus valgus
        • anterior bowing < 35°
        • posterior bowing , 10-15°
      • > 10 years old
        • varus valgus – < 5-7°
  • skeletal overgrowth is common 10-20 mm
• Skeletal Traction
  • 90-90
  • balanced traction with thomas sling
  • usually < 12 years old
  • subtrochanteric, supracondylar or unstable fracture
  • Pin 2 cm above the growth plate

Surgical Options

Indications

• larger & older children
• bilateral femoral fractures
• floating knee
• polytrauma
• open fracture
• failure of closed treatment

External Fixation

• especially if bad soft tissue envelope
• can be used with partial weight bearing

IM technique

• Rigid
  • proximal growth arrest & AVN
  • trochanteric approach
• Flexible | Nancy
  • on each side of the metaphysis distally

Plating

• Especially if multitrauma, bilateral injury, ipsilateral tibial injury
• Require later plate removal