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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Treatment options in pediatric femoral shaft fractures
1Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. janglen@iupui.edu
Insights
Pediatric femur fractures have diverse treatment options, from Pavlik Harness for infants to surgical interventions for older children. Careful technique and patient selection are crucial for optimal outcomes in pediatric femur fracture management.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
Background:
- Pediatric femur fractures present unique challenges requiring tailored treatment approaches.
- Child abuse and neglect must be considered in infant and child femur fractures.
Purpose of the Study:
- To review and compare various treatment modalities for pediatric femur fractures.
- To provide guidance on selecting appropriate interventions based on patient age, size, and fracture characteristics.
Main Methods:
- Review of current literature on pediatric femur fracture treatment.
- Analysis of different techniques including casting, external fixation, and internal fixation (flexible and rigid nailing, plate fixation).
Main Results:
- Pavlik Harness is effective for infants (0-18 months).
- Spica casting is suitable for children up to 6 years/100 pounds, with attention to technique.
- Surgical options (external fixation, intramedullary nailing, plate fixation) are superior for older/larger children, complex fractures, or associated injuries.
- Submuscular plate fixation minimizes soft tissue concerns.
Conclusions:
- Treatment selection for pediatric femur fractures depends on age, weight, fracture pattern, and associated injuries.
- Minimally invasive techniques and careful surgical approaches can optimize outcomes and minimize complications.
Abstract:
Fracture of the femur in a pediatric patient presents special problems, and a variety of treatment options. Child abuse and neglect should be considered and evaluated. Fractures in infants (0-18 months) may be treated successfully in a Pavlik Harness. Spica casting is safe and effective in children up to about 6 years or 100 pounds, although complications can occur and careful attention to technique is important. Surgical treatment is superior in most older or larger children or adolescents, and in cases of multiple trauma, soft tissue injury, obesity or head injury. External fixation is minimally invasive, but carries a risk of malunion and refracture. Rigid antegrade intramedully nailing is possible in adolescents of acceptable size, but has a risk of avascular necrosis. Flexible nailing is minimally invasive and well suited to fractures of the central 2/3 of the diaphysis. In comminuted fractures, it may require supplemental external support. Plate fixation is stable and addresses the entire length of the femur. Soft tissue concerns due to surgical exposure can be minimized by the use of submuscular placement technique.
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