To assist doctors in the management of pediatric diaphyseal femur fractures, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These problems can nearly always be resolved with further treatment. Occasionally, children will require further treatment, either early on or in subsequent years, if they have a significant difference in the length of the legs, unacceptable angulation of the healed bone, abnormal rotation of the healed bone, infection, or (rarely) if a bone fracture persists (nonunion). The intramedullary nails may need to be removed following healing if they cause irritation of the skin and tissues underneath. Generally, children who sustain a femur fracture will heal well, regain normal function, and have legs that are equal in length. Over the past decade, this treatment method has gained great acceptance. In children between 6 and 10 years old, flexible intramedullary (inside the bone) nails are often used to stabilize the fracture. These include earlier mobilization, faster rehabilitation, and shorter time spent in the hospital. In some more complicated injuries, the doctor may need to surgically realign the bone and use an implant to stabilize the fracture.ĭoctors are treating pediatric femur fractures more often with surgery than in previous years due to the benefits that have been recognized. Surgical Treatmentĭoctors generally agree that displaced femur fractures that have shortened more than 3 cm require treatment to correct at least a portion of the shortening. Traction uses a gentle, steady pulling action to properly realign the bones. Traction. If the shortening of the bones is more than 3 cm or if the bone is too crooked in the cast, it may be helpful to put the leg in traction. The femur will remodel over time so that it appears normal. Your doctor will decide which type of spica cast is most effective for treating your child's fracture.Ī femur fracture before and immediately after treatment with a spica cast. The cast may also extend down the uninjured leg, or stop at the knee or hip. There are different types of spica casts, but, in general, a spica cast begins at the chest and extends all the way down the fractured leg. In children between 7 months and 5 years old, a spica cast is often applied to keep the fractured pieces in correct position until the bone is healed. In a baby under 6 months old, a brace (called a Pavlik Harness) may be able to hold the broken bone still enough to allow for successful healing. In some femur fractures, the doctor may be able to manipulate the broken bones back into place without an operation (closed reduction). The goal of treatment is to realign the bone pieces and hold them in place for healing. Treatment depends on many factors, such as your child's age and weight, the type of fracture, how the injury happened, and whether the broken bone pierced the skin.
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