Abstract
This article discusses the incidence, applied anatomy and classification of paediatric femoral fractures based on critical appraisal of the available evidence. The aim is to identify techniques that are relevant to contemporary practice whilst excluding the technical details of individual procedures that are beyond the scope of this review. Injuries of the proximal, diaphyseal and distal segments are considered individually as there are considerations that are specific to each anatomical site. Femoral neck fractures are rare injuries and require prompt anatomical reduction and stable fixation to minimise the potentially devastating consequences of avascular necrosis. Diaphyseal fractures are relatively common, and there is a spectrum of management options that depend on patient age and size. Distal femoral fractures often involve the physis, which contributes up to 70% of femoral length. Growth arrest is common consequence of fractures in this region, resulting in angular and length-related deformity. Long-term surveillance is recommended to identify deformity in evolution and provide an opportunity for early intervention. Deliberate injury should be considered in all fractures, particularly distal femoral physeal injuries and fractures in the non-walking child.
Highlights
This article critically appraises the published evidence related to the paediatric patient with a femoral fracture, evaluating the proximal, diaphyseal and distal segments separately
Proximal and distal femoral fractures are less common, but management tends to be technically difficult, with considerable complication profiles, whilst diaphyseal fractures are more common and the treatment is dependent on the age and size of the child
Femoral neck fractures are rare injuries in children and account for approximately 1% of all paediatric fractures [1, 2]. These are associated with a high complication rate, including avascular necrosis (AVN) and mal-union, often with devastating long-term consequences [3]
Summary
This article critically appraises the published evidence related to the paediatric patient with a femoral fracture, evaluating the proximal, diaphyseal and distal segments separately. The incidence, applied anatomy, classification and contemporary management strategies are discussed. Proximal and distal femoral fractures are less common, but management tends to be technically difficult, with considerable complication profiles, whilst diaphyseal fractures are more common and the treatment is dependent on the age and size of the child
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