Paediatric Trauma: Femoral Shaft & Tibial fractures

Question 1

describe how femoral shaft fractures can occur in children

Answer 1

due to fall onto flexed knee or by indirect bending or rotational forces

Question 2

what can occur during the healing of a femoral shaft fracture in children

Answer 2

overgrowth, therefore some shortening can be accepted(more in younger kids)

Question 3

what does a femoral shaft fracture in children less than 2y/o suggest

Answer 3

NAI/child abuse(more than 50% cases), look for other signs

Question 4

what treatment is used for femoral shaft fractures in children less than 2y/o

Answer 4

Gallows traction and early hip spica cast

Question 5

what treatment is used for children between 2 and 6 with a femoral shaft fracture

Answer 5

Thomas splint or hip spica cast

Question 6

what treatment is usually used for femoral shaft fracture injuries in children 6 to 12y/o

Answer 6

femur is large enough to accommodate flexible IM nails which obviate the need for transaction or cast

Question 7

what treatment is used for femoral shaft fractures in children 12 and above

Answer 7

adult type IM nail typically used

Question 8

describe the tibial fracture commonly seen in toddlers

Answer 8

undisplaced spiral fracture of the tibial shaft (known as toddler’s fracture)

Question 9

what is the mainstay of treatment for most tibial fractures in children

Answer 9

cast

Question 10

how does the risk of compartment syndrome for children tibial fracture compare to that in adults

Answer 10

much less risk in children

Question 11

describe why serial x-rays are required in the cast management of tibial fractures in children

Answer 11

to ensure fracture does not drift into excessive angulation in the AP or lateral planes