Review Question - QID 8957

An 8-year-old child with a long oblique, length unstable femoral shaft fracture should be treated with plate fixation.

The AAOS released clinical practice guidelines where they state that length unstable fractures may make flexible nailing difficult. Long oblique fractures and fractures with comminution were defined as length unstable. They suggest that submuscular plating may be a better option for these fracture types.

Flynn et al. reviewed pediatric femoral shaft fractures and concluded that fracture pattern, stability, and location are the most important factors in determining the best treatment option. High-energy fractures with more periosteal stripping are slower to heal and more likely to shorten. Therefore, spiral, long oblique, comminuted, or very proximal or distal fractures may be less suitable for flexible nailing and should be plated.

Kocher et al. developed the AAOS clinical guideline summary. They were unable to recommend for or against the use of locked versus non-locked plates. They also were not able to recommend for or against the removal of implants in patients that were asymptomatic.

Figure A demonstrates a long oblique pediatric femoral shaft fracture.
Illustration A demonstrates AAOS Clinical guidelines for treating pediatric femoral shaft fractures.

Incorrect Responses:
Answer 1: Not appropriate for use in this age group.
Answer 2: Not appropriate for use on this fracture type. Used in length stable fractures only.
Answer 4: Not appropriate for use in this age group.
Answer 5: Not appropriate for use in this age group as the child is too large. Spica casting is appropriate up to age 5 for treatment of fractures with less than 2 cm of shortening.