Narrative review by Flynn and Schwend (2004) outlining how to select treatment for pediatric femoral shaft fractures — the most common major pediatric orthopedic injury — across age groups, fracture patterns, injury severity, and family/cost considerations. Covers the full spectrum from Pavlik harness to rigid intramedullary nailing.
When a child under 6 presents with a femoral shaft fracture, default to early spica casting in 90°/90° position and always screen for abuse — especially in infants, where nonaccidental injury accounts for 42% of cases.
When you choose surgery for a school-age child, flexible titanium elastic nails are the workhorse for mid-diaphyseal transverse fractures; save rigid nailing for the skeletally mature teenager, as osteonecrosis risk in open-physes patients is real even with correct technique.
Narrative review by Flynn and Schwend (2004) outlining how to select treatment for pediatric femoral shaft fractures — the most common major pediatric orthopedic injury — across age groups, fracture patterns, injury severity, and family/cost considerations. Covers the full spectrum from Pavlik harness to rigid intramedullary nailing.
When a child under 6 presents with a femoral shaft fracture, default to early spica casting in 90°/90° position and always screen for abuse — especially in infants, where nonaccidental injury accounts for 42% of cases.
When you choose surgery for a school-age child, flexible titanium elastic nails are the workhorse for mid-diaphyseal transverse fractures; save rigid nailing for the skeletally mature teenager, as osteonecrosis risk in open-physes patients is real even with correct technique.