Pediatric Femur Fractures

Torrance Pediatric Orthopedic Specialist

The femur, or thighbone, is the largest bone in the body and can break when high amounts of energy are transferred to the bone. In children, femur fractures may occur as a result of a fall, motor vehicle accident, or similar high-energy impact. When the femur is fractured, or when a child suffers a forceful impact to the upper leg, it should be treated as a serious injury and the child should be taken to the emergency room.

Femur fractures can range in severity, and are classified depending on their location on the thighbone, the shape of the fractured bone segments (transverse, oblique, or spiral), the position of fractured bone segments, and the number of fractured segments.

Femur fractures are considered serious injuries, especially in children. This is because they can result in severe pain, swelling or deformity, an inability to walk or stand, and a greatly reduced range of motion in the knee or hip.

Treatment for Pediatric Femur Fractures

Treatment will depend on a number of individual factors, including a child’s age and size, the type of accident that caused the injury, and whether pieces of the thighbone are stable and properly aligned or displaced and out of alignment.

Nonsurgical Treatment

With some pediatric femur fractures, the broken bone segments may be manipulated back into the correct position without surgery, this is known as closed reduction. In infants under 6 months of age, a brace may be sufficient in holding the femur in place while it heals. Other nonsurgical approaches may include:

  • Spica casting – A spica cast starts at a child’s chest and extends down to the fractured leg. It may also extend down a portion of the uninjured leg. Spica casting is used immediately after bones are manipulated into alignment, if necessary, which protects the leg and holds the bones in place so they can heal in the correct position. Spica casting is often used in children between 7 months and 5 years old.
  • Traction – When femur fractures are displaced, pieces of broken bone may overlap and shorten the normal length of the femur. If shortening is more than 3 centimeters or if the femur is still overly displaced while in a cast, traction may be used to ensure the bones are properly aligned as they heal. This will involve the child’s leg being placed in a weight and counterweight system.

Surgical Treatment

Surgery is generally used in pediatric femur fractures that have excessive bone shortening or complicated bone breaks that require surgical alignment. When performed on femur fractures in children, surgery has been found to promote faster rehabilitation, earlier movement, and shorter hospital stays.

A surgical procedure used on children between 6 and 10 years of age involves the use of intramedullary (inside bone) flexible nails to stabilize and set the fracture. With multiple fractures and bone segments, metal plates, screws, external fixators, or traction may be used. In children nearing adolescence, surgical approaches may involve the use of flexible or rigid intramedullary nails to stabilize the femur.

Surgical treatment of femur fractures has positive long-term outcomes, and children commonly regain normal function of the leg, walk and run normally, and have proportionately sized legs. In some cases, intramedullary nails used during the procedure may need to be removed after the femur heals if they cause irritation. Further treatment may also be required in some cases where legs are disproportionate in length, display angulation or rotation, or if there is a nonunion.

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Torrance Memorial Physician Network provides comprehensive care to patients and their families. For more information about our services and treating a pediatric femur fracture, call to request an appointment today.