Review Question - QID 8495

The treatment of pediatric femur fractures varies with the child's age and fracture characteristics. Children from birth to age 6 months are treated with Pavlik harness application, which provides adequate pain relief and alignment for the short duration required for healing in this age group. Between 6 months and 5 years of age, most children are treated with immediate spica casting. While there may be some exceptions (with heavier children undergoing titanium elastic nail fixation), this has been more a matter of anecdote than study. While traction remains a treatment option for many femur fractures, many centers have moved away from it because of the associated costs, both to payers and families, and the good results achieved with other methods. Because traction remains a viable treatment option for many femur fractures, it was left out of the suggested responses. Children age 5 to 11 with appropriate fractures are by and large treated with titanium elastic intramedullary nails. One exception is children with severely comminuted and length-unstable femur fracture, for whom titanium elastic nails may be less reliable and submuscular bridge plating is an excellent choice. Titanium elastic nails have also been used without undue complications in the treatment of low-grade open femur fractures, and may offer advantages over external fixation such as improved wound access and decreased refracture rates. For children older than age 11, rigid antegrade nailing through a trochanteric entry point is common. The use of a piriformis entry nail is not recommended in children.