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Femur Shaft


Fractures of the femur shaft in children are usually treated conservatively.

Babies under 12 kg

Gallows traction
  • Gallows traction
  • Both legs placed in skin traction
  • Buttocks suspended just above the mattress
  • Check circulation in legs regularly (90 deg hip flexion position conducive to vascular compromise)

It is essential to weigh the child and adhere strictly to the 12 kg limit.

Suspect non accidental injury if the child has multiple fractures at various stages of healing. Natural diseases such as osteogenesis imperfecta can mimic child abuse. Look for burns, as these together with other healing fractures suggest abuse.

Older children

    Conservative management is usually indicated. Skin traction and Thomas splint will allow most femur shaft fractures to unite in good position.

Skin traction in a Thomas Splint. Thomas Traction - Child

Details of Thomas traction in children are given on the traction page.

If cost is a problem the child may be placed in a spica cast once the fracture is partially united (week 2 or 3) and sent home for parental care.



United femur shaft fracture in a child showing bone overlapHow much shortening can be allowed in a child?

  • Up to 2.5 cm shortening is acceptable
  • Exact end to end apposition (as with plating) can cause overgrowth

When the fracture is clinically and radiologically united the traction is removed. Younger children are allowed to stand up in their cot. Once he is bearing weight the infant is allowed to mobilise outside the bed. Older children are taught to use crutches.

Operative treatment in children

Older children with bigger muscle mass may need more than the 5kg limit imposed by skin traction. In these individuals operative treatment is indicated.

Surgical Options

  • Plates and screws. Require a large wound and may become septic or break.
  • Flexible intramedullary nails.From 6 yrs onwards multiple flexible nails can be used, inserted from the distal metaphysis towards the proximal femur. Femur fracture treated by TENS nails
  • IM Locking pin as with adults. - use only in the older (prepubital) child as damage to the growth plates and avascular necrosis of the femoral head are a risk.

Age and treatment method

Opinion as to the most appropriate method of treatment at various ages varies depending on experience of the surgeon, affordability and other factors. In addition skeletal maturity and size of the child play a role to decide the treatment modalityrecommended. The following table can be taken as a rough guide:-

Femur Shaft: Method of treatment
0 - 6 months Pavlic harness
6 months - 2yr Gallow's traction ( N. B. Must be under 12 kg in weight)
2 - 6 yr Skin traction and Thomas splint
6 - 12 yr Titanium Elastic Nails
> 12 yr Locked intramedullary nails



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