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Current controversies in the treatment of pediatric femoral shaft fractures

Beebe, Michael J.; Kelly, Derek M.; Warner, William C. Jr; Sawyer, Jeffrey R.

doi: 10.1097/BCO.0b013e3181baee8b
SPECIAL FOCUS: Pediatric Orthopaedics

Treatment of pediatric femoral shaft fractures depends on the age of the patient. However, factors, such as weight and size may affect the modality used. In children between the ages of 0–6 months, treatment is through the use of a Pavlik harness worn for 4 weeks. This usually results in an acceptable outcome because of the remodeling potential in children younger than 2 years. Children between the ages of 6 months and 5 years can be treated with immediate spica casting or traction and delayed spica casting, although good results are being reported with titanium elastic intramedullary nailing in this age group. From 6–9 years, titanium elastic intramedullary nailing is the treatment of choice, with spica casting rarely, if ever, used. Rigid nailing is considered a viable option for children who are near the age of 10 years or in large children. External fixation in this age group is reserved for patients with gross comminution or soft-tissue injury. For patients older than 10 years or patients weighing more than 100 lbs, locked intramedullary nailing is being used with good results, although avascular necrosis of the femoral head is still a concern in patients with open physes.

aUniversity of Tennessee-Campbell Clinic, Memphis, Tennessee

Correspondence to Jeffrey R. Sawyer, MD, Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138

Tel: +901 759 3277; fax: +901 759 3278;


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