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AAOS Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures

Jevsevar, David S. MD, MBA; Shea, Kevin G. MD; Murray, Jayson N. MA; Sevarino, Kaitlyn S. MBA

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: December 2015 - Volume 23 - Issue 12 - p e101
doi: 10.5435/JAAOS-D-15-00523
Guest Editorial

From the Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr. Jevsevar), St. Luke's Clinic–Intermountain Orthopaedic, Boise, ID (Dr. Shea), and the Department of Research and Scientific Affairs, the American Academy of Orthopaedic Surgeons, Rosemont, IL (Mr. Murray and Ms. Sevarino).

Dr. Shea or an immediate family member serves as an unpaid consultant to Clinical Data Solutions, Source Trust and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, North Pacific Orthopedic Society, and Pediatric Orthopaedic Society of North America. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Jevsevar, Mr. Murray, and Ms. Sevarino.

Received June 22, 2015

The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors recently approved the reissue of the Clinical Practice Guideline (CPG) Treatment of Pediatric Diaphyseal Femur Fractures, originally published in 2009.1 After conducting a new literature search, it was found that no new literature has been published that would alter the original recommendations. The guideline was reissued with the following updates:

  • An additional study (Shemshaki et al2) was added in support of the recommendation on elastic intramedullary nails; this study did not alter the recommendation’s strength (Limited).
  • The language to describe the strength of the recommendation was updated to reflect current practices in AAOS guideline language.
  • Inconclusive recommendations worded as “we cannot recommend for or against” a given intervention were removed to reflect current AAOS guideline processes that do not allow recommendations without any supporting evidence in AAOS CPGs.

The full CPG document containing the systematic review of the literature and the work group disclosures, along with all supporting documentation, is available on the AAOS Website at and/or the AAOS OrthoGuidelines website at

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1. American Academy of Orthopaedic Surgeons: Treatment of Pediatric Diaphyseal Femur Fractures: Evidence-Based Clinical Practice Guidelines. Accessed September 22, 2015.
2. Shemsaki HR, Mousavi H, Salehi G, Eshaghi MA: Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children. J Orthop Traumatol 2011;3(1):45–48.
© 2015 by American Academy of Orthopaedic Surgeons