Pediatric Femur Fractures Guidelines

Updated: Sep 29, 2023
  • Author: Karthik S Murugappan, MBBS, MS(Orth), DNB, MRCS; Chief Editor: Jeffrey D Thomson, MD  more...
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AAOS Guidelines on Treatment of Pediatric Diaphyseal Femur Fractures

In 2020, the American Academy of Orthopaedic Surgeons (AAOS) issued updated guidelines for pediatric diaphyseal femur fractures. [21] Recommendations included the following:

  • Strong evidence supports the position that children younger than 36 months with a diaphyseal femur fracture should be evaluated for child abuse.
  • Limited evidence supports treatment with a Pavlik harness or a spica cast for infants aged 6 months or younger who have a diaphyseal femur fracture; outcomes are similar.
  • Moderate evidence supports early spica casting or traction with delayed spica casting for children aged 6 months to 5 years who have a diaphyseal femur fracture with < 2 cm of shortening.
  • Limited evidence supports the option to use flexible intramedullary nailing for treatment of children aged 5-11 years with diagnosed diaphyseal femur fractures.
  • Limited evidence supports rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing as treatment options for children diagnosed with diaphyseal femur fractures from the age of 11 years to skeletal maturity; piriformis and near-piriformis entry rigid nailing are not options.
  • Limited evidence supports regional pain management for patient comfort perioperatively.
  • Limited evidence supports waterproof liners for spica casts as an option for children diagnosed with pediatric diaphyseal femur fractures.