Pediatric femur fracture treatment
The right treatment and surgery for femur fractures in children is determined by a number of factors, including the age of the child, present health, health history, severity and location of the fracture and history with other medications and treatments. Femur fractures in children are almost always caused by trauma and require immediate treatment to avoid deformity or bad development of the child’s bones.
A femur fracture in a child can be extremely dangerous if not treated quickly. If you suspect your child may have a fracture in the thighbone, it is important to seek medical attention immediately. The doctor will ask questions to better understand the specifics of the activity leading up to the broken bone and will perform a physical exam. To find out the full extent of the fracture, the following techniques may be used:
- X-ray (radiograph) – This will be the first test to find the location and extent of the fracture. It is done using electromagnetic radiation, which will be sent in the direction of the child’s thighbone. Bone absorbs the radiation, which allows an image of the affected area to be created.
- Computed tomography scan (CT or CAT scan) – A CAT scan combines X-ray technology with advanced computer technology to generate an image of the injury in 3-D. This image can also show soft tissue damage.
- Magnetic resonance imaging (MRI) – In some cases, a doctor may order an MRI to be performed because, unlike CAT scans and X-rays, it does not use radiation. This imaging test can also give a view of the tissue and bone in the thigh area, making it easier to see the extent of the injury.
- Bone scan – In children, damage to growth plates, which help the bones grow to their mature size, is important to diagnose early. With a bone scan, this is easier. It uses a combination of CAT scan and X-ray technology and involves a dye being injected into the site of the fracture, showing the metabolism and the cell activity.
If the femur fracture is easy to realign, a spica cast (also known as a body cast) may be used for healing. This is a cast that begins at the child’s chest and extends down the affected leg. To get the child into a spica cast, mild sedatives may be needed. If there is concern over growth patterns, traction may be used instead. This involves a weight and pulley system and will immobilize your child for an extended period. However, it ensures that the bone continues to develop naturally as it heals, so growth is not stunted.
In most cases, femur fractures in children require surgery. The aim of most femur fracture surgeries in children is similar to that in adults: to reconnect broken bones and allow them to heal without complications. In children, the issue of growth is an important consideration, so surgery is used more often to ensure the fast repair of the bone. The majority of femur fractures in children are treated in one of the following ways:
- Flexible nails inside the bone – This method of treatment in children has gained popularity. It is usually used on children aged six through 10 and involves using a flexible nail down the middle of the bone to help stabilize it as it heals. This surgery usually leads to regaining mobility more quickly.
- Plate and screws – If the bone has too many broken pieces, it may require a plate and screws to be used to help stabilize the area. This involves putting a plate alongside the site of the fracture and using screws in the healthier part of the bone to hold everything in place.
- External fixation – In older children, an external rod may be placed on the outside of the leg to hold the bone in place. Then, screws are placed through the skin and into the bone to keep the fracture stabilized. This is most commonly used when there has been tissue damage due to the injury.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs femur fracture surgery in children as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.
As the research surrounding femur fractures in children is ongoing, a trend in this type of injury has been spotted. There is a significant spike in this type of broken bone in children under the age of 18 months and over the age of six years old. While it is still unclear why there is a drop between the age groups, the cause of these thighbone injuries in the younger age group is far different from that of those injuries in the older group.
In infants, particularly those who are not able to walk, femur fractures are typically caused by abuse, according to research studies. This is an important finding because it helps doctors discover these cases early on, stopping possible future injuries for non-accidental reasons. One study found that transverse fractures are the most common in abuse cases.
A transverse fracture is one where the bone breaks completely. It is caused by significant trauma. Most children in their early teens who undergo these sorts of fractures do so from high-intensity motor vehicle accidents or falls. However, in children who are not able to walk, the cause of this injury is typically considered non-accidental. There are ongoing studies to help doctors determine the causes of these fractures and how they can best treat patients while also caring for their long-term well-being.
As research on diagnosis and treatment is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.