Preoperative Immobilization for Pediatric Femur Fractures

Guidelines for the definitive surgical management of pediatric femoral shaft fractures have recently been established. Initial preoperative immobilization of these patients varies by age and size; limited guidelines exist to guide caregivers in appropriate preoperative care. Here, we present our recommendations based on clinical experience and literature review. We prefer temporary splints for patients younger than 5 years and Bucks boot traction for skeletally immature patients older than 5 years. In small patients, the splint should extend past the iliac crest and down to the foot to ensure proper immobilization of the femur fracture. For Bucks boot traction, proper traction weight-to-patient weight ratio (0.5-1 pound per year of age, up to 10 pounds) and gatching the bed will help limit complications. We reserve skeletal traction for adolescents and skeletally mature patients with femur fractures or for those in the setting of polytrauma. Understanding proper preoperative immobilization is essential for the entire care team to ensure patient comfort and reduce complications while awaiting definitive management.

(1)Similar to definitive fixation, femur fracture preoperative immobilization techniques vary based on the patient's age and size.(2)Patients under 5 years of age can be properly immobilized with a posterior splint that extends from just above the iliac crest on the lower back to the foot.(3)In the 5+-year-old age range, Buck's traction is used, and an adjustable gatch bed can help prevent patients from being pulled distally.(4)Skeletal traction is indicated for large adolescent or polytraumatized patients with a femur fracture or unstable hip fracture dislocations.