Current concepts in pediatric femur fracture treatment

Orthopedics
Enes M Kanlic, Miguel Cruz

Abstract

Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or < 2 cm of shortening on presentation, are treated with one-leg spica casting (if the patient weighs < or = 50 lb. "transportable"). Unstable, complex (multifragmentary) and significantly displaced high energy shaft fractures are treated operatively. Transverse or short oblique shaft fractures in patients < 12 years may be treated with elastic intramedullary nails. Bridge plating will provide better stability in complex fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures with severe soft tissue injuries could be temporized with external fixation. Distal physis and epiphyseal injuries require anatomical reduction and smooth wires and/or screw fixation (placed in such a way as to minimize further damage to the physis) and need to be augmented with ...Continue Reading

Citations

Jul 3, 2013·Journal of Children's Orthopaedics·Richard A K ReynoldsJean-Michel Clavert
Sep 11, 2013·Journal of Pediatric Orthopedics·Walter P SamoraKevin E Klingele
Jun 1, 2011·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·T SlongoS M Berger
Oct 2, 2020·World Journal of Orthopedics·Eric Andrew MussellShawn R Gilbert
Jan 13, 2010·The Journal of Trauma·Charles M Court-BrownBen Caesar
Jan 17, 2014·Journal of Children's Orthopaedics·Collin MayBenton E Heyworth
Mar 30, 2013·Clinical Orthopaedics and Related Research·Amr A AbdelgawadEnes M Kanlic
Aug 10, 2019·Case Reports in Orthopedics·Jonathan BryantDaniel Krenk
Sep 8, 2012·Journal of Pediatric Orthopedics·Tali BeckerElhanan Bar-On
Mar 22, 2013·The Journal of Bone and Joint Surgery. American Volume·Benton E HeyworthYi-Meng Yen
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