Fractures of the femur shaft in children are usually treated conservatively.
Babies under 12 kg
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.
Conservative management is usually indicated. Skin traction and Thomas splint will allow most femur shaft fractures to unite in good position.
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.
How much shortening can be allowed in a child?
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.
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:-