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Femur Fractures in Children Treatment

To treat a child's fractured femur, the pieces of bone are realigned and held in place for healing. Treatment depends on many factors, such as your child's age and weight, the type of fracture, how the injury happened, and whether the broken bone pierced the skin.

How is a child’s femur fracture treated without surgery?

In some thighbone fractures, the doctor may be able to move the broken bones back into place without surgery. In a baby under 6 months old, a brace (called a Pavlik Harness) may be able to hold the broken bone still enough for successful healing.

Spica casting

Spica Cast

A thighbone fracture before and immediately after treatment with a spica cast. The femur will remodel over time so that it appears normal.

In children between 7 months and 5 years old, a spica cast is often applied to keep the fractured pieces in correct position until the bone is healed. There are different types of spica casts, but, in general, a spica cast begins at the chest and extends all the way down the fractured leg. The cast may also extend down the uninjured leg, or stop at the knee or hip. Your doctor will decide which type of spica cast is most effective for treating your child's fracture.

Your doctor will sedate your child for the closed reduction, and apply a spica cast immediately (or within 24 hours of hospitalization) to keep the fractured pieces in correct position until healing occurs.

When a bone breaks and is displaced, the pieces often overlap and shorten the normal length of the bone. Because children's bones grow quickly, your doctor may not need to manipulate the pieces back into perfect alignment. While in the cast, the bones will grow and heal back into a more normal shape. In general, for the best results, the broken pieces should not overlap more than 2 cm when in the cast. The growth of the femur may be temporarily increased by the trauma. The mild shortening from the overlap will resolve.

Traction

If the shortening of the bones is too much (more than 3 cm) or if the bone is too crooked in the cast, it may be helpful to put the leg in a weight and counterweight system (traction) to make sure the bones are properly realigned.

How is a child’s femur fracture treated with surgery?

In some more complicated injuries, the doctor may need to surgically realign the bone. Today, doctors are treating pediatric femur fractures with surgery more often than in previous years. There are many benefits to treating a femur fracture with surgery including being able to move sooner, faster rehabilitation, and less time spent in the hospital.

In children between 6 and 10 years old, flexible intramedullary (inside the bone) nails are often used to stabilize the fracture.

Femur Fracture Repair

(Left) Preoperative X-ray of a child with a fracture through the midshaft of the left femur. (Right) Postoperative X-ray of the same child shows that the fracture was treated with internal flexible nailing to restore stability and allow early mobilization.

Occasionally, the broken bone has too many pieces and cannot be treated successfully with flexible nails. Other options that can lead to successful outcomes in this situation include:

  • A plate with screws that "bridges" the fractured segments
  • An external fixator — this is often used if there has been a large open injury to the skin and muscles

External Fixation

External fixation is often used to hold the bones together when the skin and muscles have been injured.

Prolonged traction with a pin temporarily placed into the thighbone

As the child nears the teenage years (11 years to skeletal maturity), the most common treatment choices include either flexible intramedullary nails or a rigid locked intramedullary nail. The rigid nail is particularly useful when the fracture is unstable. Both types of nails allow for the child to begin walking immediately.

A rigid, locked intramedullary nail is often used for femur fractures in adolescents who are nearly full grown.

How long will it take a child to recover from a fractured femur?

Generally, children who fracture their femur will heal well, regain normal function, and have legs that are equal in length. The intramedullary nails may need to be removed following healing if they cause irritation of the skin and tissues underneath.

Sometimes, children will require further treatment, either early on or in subsequent years, if their legs are different lengths, unacceptable angulation of the healed bone, abnormal rotation of the healed bone, infection, or (rarely) if a thighbone fracture persists (nonunion).

These problems can nearly always be resolved with further treatment.