Treatment of Pediatric Diaphyseal Femur Fractures

J Am Acad Orthop Surg, Vol 17, No 11, November 2009,

Mininder S. Kocher, MD, MPH, Ernest L. Sink, MD, R. Dale Blasier, MD, Scott J. Luhmann, MD, Charles T. Mehlman, DO, MPH, David M. Scher, MD, Travis Matheney, MD, James O. Sanders, MD, William C. Watters, III, MD, Michael J. Goldberg, MD, Michael Warren Keith, MD, Robert H. Haralson, III, MD, MBA, Charles M. Turkelson, PhD, Janet L. Wies, MPH, Patrick Sluka, MPH and Kristin Hitchcock Methods of treating pediatric diaphyseal femur fractures are dictated by patient age, fracture characteristics, and family social situation. The recent trend has been away from nonsurgical treatment and toward surgical stabilization. The clinical practice guideline on pediatric diaphyseal femur fractures was undertaken to determine the best evidence regarding a number of different options for surgical stabilization. The recommendations address treatments that include Pavlik harness, spica casts, flexible intramedullary nailing, rigid trochanteric entry nailing, submuscular plating, and pain management. The guideline authors conclude that controversy and lack of conclusive evidence remain regarding the different treatment options for pediatric femur fractures and that the quality of scientific evidence could be improved for the revised guideline. This clinical practice guideline was approved by the American Academy of Orthopaedic Surgeons on June 19, 2009.