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J Am Acad Orthop Surg, Vol 12, No 5, September/October 2004, 347-359.
© 2004 the American Academy of Orthopaedic Surgeons
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Management of Pediatric Femoral Shaft Fractures

John M. Flynn, MD and Richard M. Schwend, MD

Dr. Flynn is Attending Surgeon, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, and Associate Professor, Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA. Dr. Schwend is Chief, Division of Pediatric Orthopaedics, Carrie Tingley Hospital, Department of Orthopaedics, University of New Mexico, Albuquerque, NM.

Reprint requests: Dr. Flynn, The Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104.

Femoral shaft fractures are the most common major pediatric injuries managed by the orthopaedic surgeon. Management is influenced by associated injuries or multiple trauma, fracture personality, age, family issues, and cost. In addition, child abuse should be considered in a young child with a femoral fracture. Nonsurgical management, usually with early spica cast application, is preferred in younger children. Surgery is common for the school-age child and for patients with high-energy trauma. In the older child, traction followed by casting, external fixation, flexible intramedullary nails, and plate fixation have specific indications. The skeletally mature teenager is treated with rigid intramedullary fixation. Potential complications of treatment include shortening, angular and rotational deformity, delayed union, nonunion, compartment syndrome, overgrowth, infection, skin problems, and scarring. Risks of surgical management include refracture after external fixator or plate removal, osteonecrosis after rigid antegrade intramedullary nail fixation, and soft-tissue irritation caused by the ends of flexible nails.




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