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Femoral fractures in children from 4 years to 10 years: conservative treatment
J Casas1, G Gonzalez-Moran, J Albiñana
1Orthopaedic Department, Santa Rosa Children's Hospital, San Antonio, Texas, USA.
Insights
Conservative treatment for pediatric femoral shaft fractures (ages 4-10) is safe and effective. This study found no significant complications, supporting non-surgical management for these isolated fractures.
Area of Science:
- Pediatric Orthopedics
- Traumatology
Background:
- Surgical interventions for pediatric femoral shaft fractures are increasingly common.
- Conservative management options warrant further investigation for specific age groups.
Purpose of the Study:
- To evaluate the outcomes of conservative treatment for isolated femoral shaft fractures in children aged 4 to 10 years.
- To assess the safety and efficacy of non-operative management in this pediatric population.
Main Methods:
- Retrospective analysis of 41 children with closed, isolated, diaphyseal femoral fractures.
- Treatment involved skin traction followed by spica casting, with serial radiographic monitoring.
- Angular deformity assessed using diaphyseal and interphyseal angles.
Main Results:
- No significant complications such as leg-length discrepancy or refractures were observed.
- Mean hospitalization was 20.7 days and casting duration was 9.7 weeks.
- Conservative treatment demonstrated favorable outcomes without major adverse events.
Conclusions:
- Conservative management, including skin traction and spica casting, is a safe and effective approach for isolated femoral shaft fractures in children aged 4 to 10 years.
- This non-operative strategy can yield excellent results, challenging the necessity of surgical intervention in all cases.
Abstract:
Some authors have widened the indications for surgical management of isolated femoral shaft fractures in children between 4 years and 10 years of age. We address this study to evaluate the results of such femoral fractures treated conservatively in 41 children. All fractures were closed, isolated, and diaphyseal. The mean age was 6.5 years (standard deviation, 1.7 years) and the mean follow-up was 2.3 years (standard deviation, 1.7 years). All fractures were managed conservatively with skin traction (mean hospitalization time, 20.7 days), alignment of the fragments was serially followed by X-ray, and a spica cast was applied (9.7 weeks), usually without a general anesthesia. Angular deformity was assessed by measurement of the fracture-site diaphyseal angle as well as by measurement of the interphyseal angle described by Wallace and Hoffman. No significant complications were recorded regarding leg-length discrepancy, deformity, refractures, etc. Mean cost is not a factor in determining method of treatment at our hospital. We feel that this type of fracture in the 4 years to 10 years age group can be safely treated with a conservative approach.