Femoral Shaft Fractures in Emergency Medicine Guidelines

Updated: Nov 13, 2019
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines Summary

AAOS guidelines for diaphyseal femur fracture in children

American Academy of Orthopaedic Surgeons (AAOS) guidelines for treatment of diaphyseal femur fractures in children include the following [16] :

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