Femur Fractures

Question 1

What is a common mechanism of femur shaft fractures in pediatrics?

Answer 1

Child abuse; must suspect if femur fx

Question 2

What are the treatment guidelines for femur fractures in pediatric patients?

Answer 2

2-3 cm shortening; spica, flex nails, ex fix, ORIF
6y-11y: If length stable; flex nails
If length unstable or very proximal or distal; ORIF
>11y: If length stable and 45kg; lateral entry IMN
If very proximal or distal; ORIF

Length stable: transverse or short oblique
Length unstable: spiral or comminuted

Question 3

What are common complications of femur shaft fractures in pediatric patients?

Answer 3

1) LLD; typically 0.7-2cm of overgrowth occurs; presents within 2 yrs
2) Osteonecrosis of femoral head; a/w IMN
3) Nonunion; flex nails in >45kg; ex-fix and ORIF titanium flex nails
4) Malunion; typically in varus; rotation doesn’t remodel