Pediatric femoral shaft fractures: Current and future treatment

Femoral shaft fractures are common in pediatric age groups. Children under the age of 2 years should be evaluated for evidence of non-accidental trauma (child abuse). Treatment of the fracture is dependent on the patient's age, weight, fracture configuration, soft-tissue injury, presence of other injuries and social situation. Pavlik harness treatment is preferred during the first 3 months of life and can be utilized up to 1 year of age. Immediate spica casting is most commonly used from 3 months to 5 years of age. Flexible intramedullary nailing has revolutionized the treatment of pediatric fractures and is most commonly used in the west for pediatric femur fractures in patients 5-12 years of age. Patients 12 years of age up to skeletal maturity present a dilemma and, most recently, lateral trochanteric nailing has been shown to be a safe option without the risks associated with nailing through the piriformis fossa in adolescents. Submuscular plate stabilization has been demonstrated by a number of authors to be a safe and effective method of stabilizing unstable fractures in all age groups from toddlers to skeletal maturity. External fixation, most often using monolateral external fixators, provides an effective method of treating polytraumatized patients and severe open fractures without internal fixation. The method is effective but has decreased in popularity in the west with reports of high rates of refracture.