Algorithm for the management of femoral shaft fractures in children

Purpose: Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment. Materials and methods: Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF). Results: Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in both types of treatment. Patients treated with EF had shorter limb length discrepancy compared with SC. There were no reports of re-fracture. We found a higher familiar satisfaction in patients treated with EF. Conclusions: An algorithm for the management of femoral shaft fractures in the pediatric population is proposed. Results on the study population gave raise to a satisfactory clinical and radiological results.