Treatment of Pediatric Diaphyseal Femur Fractures: Spica Casting and Traction

Abstract

Femoral shaft fractures remain a common musculoskeletal injury requiring inpatient care for children. The use of casting and traction in the treatment of femoral shaft fractures has a long and storied tradition in the history of orthopedic surgery. National trends in orthopedics have shifted away from traction and hip spica casting despite continued satisfactory clinical outcomes with this treatment. Current recommendations are for immediate hip spica casting in children between ages of 6 months and 5 years. In children of this age with more than 2 cm of shortening on injury films, traction may be done for a period of time prior to hip spica casting in order to obtain stability and alignment. In children aged 6–12, the use of traction and hip spica casting is losing favor. Flexible nails, external fixators, submuscular plating, and at some institutions lateral- or trochanteric-entry rigid nailing are replacing traction and casting in this age group. Factors associated with preference toward operative treatment, rather than traction and casting in this age group, include shorter hospital stays, early mobilization, and a smaller burden on caretakers. Despite this trend away from traction and hip spica casting, management of pediatric femoral shaft fractures with traction and casting still has an important place in the armamentarium of the pediatric orthopedic surgeon.