Pediatric Femur Fractures Treament

Femur fractures are not uncommon injuries in children. Fortunately, most femur fractures heal well, even with nonsurgical treatments. The amount of displacement (separation of the bone ends) that can be accepted depends on the child's age, with even widely displaced fractures healing in young children. Therefore, determining the treatment of femur fractures is largely distinguished by the age of your child.

Boy helping friend with crutches
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In Infants

Femur fractures in infants and toddlers will usually heal with cast treatment. In early infancy, a Pavlik harness may be worn instead of a spica cast.

Due to the rapidly growing bone in young children, the bone ends do not need to be perfectly aligned. The bone will remodel over time to the point where it may not even be evident the bone had been injured. Most infants and toddlers will require spica casting for about 4 to 6 weeks to allow for adequate bone healing.

In Early Childhood

In younger children (under age 6), spica casting is usually sufficient for the treatment of a femur fracture. The duration of casting may be slightly longer as children get older, but the bone still has excellent potential for healing.

There is a judgment that is made by your orthopedic surgeon and you (as the parents) when deciding how to best treat children in the 5- to- 7-year-old range. As mentioned, these kids are often treated well as young children in a spica cast. In other situations, your healthcare provider may recommend surgery to insert flexible rods inside the bone. You can discuss the pros and cons with your healthcare provider.

In Later Childhood

There is no clear cutoff for when spica casting becomes less practical, but you can discuss options with your healthcare provider. The most commonly performed surgical treatments for femur fractures are:

  • External Fixation: External fixation uses a rod outside of the body that is attached to the bone with long pins or screws. The use of external fixators is limited, especially because of such good results with the flexible rods. The external fixators are often used with open fractures or when the fractured bone is in many pieces (comminuted).
  • Flexible Rods: The most common treatment for older children (ages 7 to 12) is a flexible intramedullary rod. These rods are easily inserted into the hollow center of the bone and easily removed after treatment. The rods are inserted just above the knee and do not cross the growth plate. They are not rigid, and therefore, cannot support the child. Since these young children still heal very quickly, however, they tend not to cause problems.
  • Standard Rods: Intramedullary rods are the standard treatment for a femur fracture in an adult. Only once a child's growth plates have closed should this type of rod be used. Around the ages of 11 to 14, most femur fractures will be treated the same as they are treated in an adult.

Determining the best treatment for a particular situation depends on a number of factors, not just the age of your child. These are general approaches for the treatment of many common femur fractures, but each and every child will have individual circumstances which may alter the recommended treatment approach.

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  • Staheli LT, "Practice of Pediatric Orthopedics" Lippincott Williams & Wilkins © 2001. Page 234.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.