(i) Femoral shaft fractures: North American and European perspectives

Abstract

Femoral fractures are the commonest fracture of the lower extremity in children. The aim of treatment is to restore the child to normal function as quickly and effectively as possible. Problems with all treatments include malunion, stiffness and refracture. Intramedullary nails have additional problems with avascular necrosis of the femoral head and arrest of the greater trochanter apophysis. Traditional methods of casting and traction may cause pressure sores and pin site infection is common with external fixatiors. Treatment of these fractures in the UK has usually been traction and late casting in a skeletally immature child. In continental Europe, the use of flexible intramedullary nails is more common. In North America, treatment is based on the age of the child. Under the age of 10 years, an early hip spica is used. Flexible intramedullary nails are used for children over 10 years of age and rigid nails for skeletally mature children. The final decision depends on patient, family and surgeon preference plus the availability of resources.