KUMJ | VOL. 12 | NO. 1 | ISSUE 45 | JAN-MAR, 2014
Controversies in Orthopaedic Trauma- Management of Fractures of Shaft of Femur in Children Between 6 and 12 Years of Age
Jain A, Aggarwal A, Gulati D, Singh MP
Abstract: The management of femoral shaft fractures in children is largely directed by the
age and built of the child. There is wide consensus on the non operative treatment
of children less than six years of age. Operative treatment is recommended for
children more than 12 years of age, only the surgical options vary. The age group of
6-12 years remains a controversial area with multiple studies advocating different
lines of treatment.
We studied the literature on treatment of femoral shaft fractures in 6 to 12 year age
group over the past 25 years through PubMed search and found 79 studies dealing
with management of paediatric shaft femur fractures in this age group. Studies
dealing with other age groups, animal studies and languages other than English
were excluded. The treatment modalities included early or immediate hip spica,
traction alone, external fixator, plating (open/minimally invasive), intramedullary
nailing- rigid/flexible and intramedullary Kirschner wire. The short listed articles
were studied for rate and time of union, complications such as non-union and
malunion, leg length discrepancy, infection, implant impingement, refracture and
cost analysis.
Operative treatment is usually the preferred treatment option in this age group,
as it decreases hospitalization time, decreases morbidity and allows early return
of child to school. Flexible intramedullary nailing is recommended for length
stable fractures. Submuscular bridge plating (minimally invasive) is reserved
for comminuted fractures. External fixator is reserved for open fractures and
initial stabilization of femoral shaft fractures in polytrauma pediatric patients.
Intramedullary K wire is a viable option in resource contrained centres where
specialized implants and instrumentation is not available.
Keyword : Children, femur, fracture, paediatric, shaft
