[Interpretation of American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures].

Abstract

The original guideline on the Treatment of Pediatric Diaphyseal Femur Fractures (PDFF) was developed by the American Academy of Orthopaedic Surgeons (AAOS) in 2009, and the guideline was updated by AAOS in 2015. In this reissue, all recommendations in the original guideline identified as"inconclusive" were removed with seven recommendations reserved and without new recommendations added. The recommendations in the current guideline were listed as follows: (1) Children younger than 36 months with PDFF should be evaluated for child abuse. (2) Pavlik harness or spica cast might be used for infants 6 months and younger with a PDFF. (3) Early spica casting or traction with delayed spica casting could be used for children aged from 6 months to 5 years with a PDFF with less than 2 cm of shortening. (4) Waterproof cast liners might be used for spica casts. (5) Flexible intramedullary nailing might be sugested to treat children aged from 5 to 11 years with PDFF. (6) Rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing might be treatment options for children aged over 11 years to skeletal maturity with PDFF. (7) Regional pain management could be used for patient comfort perioperatively. This paper makes interpretation for this guideline with the aim to provide reference for pediatric surgeons to select appropriate treatment methods for patients with PDFF.