This 2009 AAOS clinical practice guideline summarizes a systematic review of pediatric diaphyseal femur fracture treatment across four age groups — infants, ages 6 months–5 years, 5–11 years, and 11 years to skeletal maturity — producing 14 recommendations covering Pavlik harness, spica casting, flexible nailing, rigid trochanteric nailing, submuscular plating, and perioperative pain management.
When selecting fixation for a pediatric femur fracture, age and weight are your primary filters: flexible nails are appropriate for ages 5–11 under 49 kg, trochanteric entry rigid nailing or submuscular plating for heavier/older children, and piriformis entry nailing is off the table entirely in skeletally immature patients.
Any child under 3 with a femur fracture requires a formal abuse workup — not just a history, but communication with the pediatrician and selective skeletal survey.
This 2009 AAOS clinical practice guideline summarizes a systematic review of pediatric diaphyseal femur fracture treatment across four age groups — infants, ages 6 months–5 years, 5–11 years, and 11 years to skeletal maturity — producing 14 recommendations covering Pavlik harness, spica casting, flexible nailing, rigid trochanteric nailing, submuscular plating, and perioperative pain management.
When selecting fixation for a pediatric femur fracture, age and weight are your primary filters: flexible nails are appropriate for ages 5–11 under 49 kg, trochanteric entry rigid nailing or submuscular plating for heavier/older children, and piriformis entry nailing is off the table entirely in skeletally immature patients.
Any child under 3 with a femur fracture requires a formal abuse workup — not just a history, but communication with the pediatrician and selective skeletal survey.