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Pediatric Femoral Fracture

Articlepediatricfemoralfracture
Bone, Muscle, & Joint
Kids' Zone
+1
Contributed byMaulik P. Purohit MD MPHDec 16, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Femoral Fracture in Children and Adolescents
  • Thighbone Fracture in Children and Adolescents

What is Pediatric Femoral Fracture? (Definition/Background Information)

  • The femoral shaft (thighbone) is the longest and strongest bone within the human body
  • A fracture of the femoral shaft is a break or crack that occurs anywhere in the center region (length) of the femur
  • Femoral shaft fractures are among the most frequent childhood injuries; a common cause of hospitalization attributed to orthopedic reasons
  • A Pediatric Femoral Fracture is usually caused by a sudden and forceful impact on the leg
  • Treatment associated with the injury includes nonsurgical and surgical methods

There are several different types of thighbone fractures, some of which are categorized based on the injury impact force. The fracture types include:

  • Displaced fracture: In this type of fracture, the bone may fragment around the point of breakage and get misaligned; hence, surgery is usually required
  • Close fracture: In this type, the bones do not pierce the skin. However, injury to the soft tissues under the skin, may occur
  • Open fracture: In this type of fracture, the bone breaks and pierces the skin, requiring immediate medical treatment. Apart from this, ligament, muscle, and tendon damage, may also occur. Open fractures are usually rare

Who gets Pediatric Femoral Fracture? (Age and Sex Distribution)

  • Pediatric Femoral Fractures are non-specific fractures and may occur in children of any age, race, ethnic group, and gender
  • It is generally observed that children under the age of 1 year have the highest rate of incidence, usually as a result of child abuse

What are the Risk Factors for Pediatric Femoral Fracture? (Predisposing Factors)

Common risk factors associated with a Pediatric Femoral Fracture include:

  • Participation in high-risk contact sports
  • Excess body weight associated with obesity, which can cause increased pressure on the joints
  • Low calcium diet
  • Previous history of fractures

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pediatric Femoral Fracture? (Etiology)

A majority of Pediatric Femoral Fractures are the result of:

  • Direct trauma to the leg associated with an automobile accident
  • Children who participate in any rough or high-impact sports
  • Falling from a significant height (or the fracture occurring since the child is overweight)

In infants up to a year old, such fractures generally occur due to:

  • Child abuse
  • Osteogenesis imperfecta, a genetic defect that is characterized primarily by fragile bones, caused by a deficient production of collagen (naturally occurring protein found in tissues, ligaments, cartilages, and bones)
  • Difficult delivery during childbirth

What are the Signs and Symptoms of Pediatric Femoral Fracture?

Signs and symptoms of a Pediatric Femoral Fracture include:

  • Sharp and sudden pain in the leg, immediately after the injury occurred
  • Swelling, tenderness, and possible bruising around the injury site
  • Noticeable deformity of the leg
  • Reduced range of motion of the hip or knee
  • Inability of the child to put weight/pressure on the injured leg
  • Difficulty walking
  • Excessive pain, especially on touching the leg

How is Pediatric Femoral Fracture Diagnosed?

Diagnostic methods that a physician may use to help diagnose a Pediatric Femoral Fracture include:

  • Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, contusions, and shortening or angulation of the leg. Parents or guardians of the childare also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
  • X-ray: X-rays are the most common imaging methods in evaluating a fracture; to see if there has been a bone displacement. The physician will also study the x-ray for any damage to the growth plate (area of tissue growth at the end of long bones in children). This diagnostic test can help provide a clear image of the bone, identify exact location of the injury, and determine the extent of the fracture

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pediatric Femoral Fracture?

Complications from a Pediatric Femoral Fracture could include:

  • Infection of the bone (osteomyelitis)
  • Damage to the nerves or blood vessels of the leg
  • Prolonged or delayed healing process, due to other medical conditions
  • Abnormal pressure build-up in the leg muscles, which can reduce blood flow and prevent nourishment and oxygen from reaching nerve and muscle cells (called compartment syndrome)
  • Arthritis may develop, if the fracture impacts the joints, or if the bone is improperly aligned
  • Uneven leg length, due to growth plate complications

How is Pediatric Femoral Fracture Treated?

The goal of Pediatric Femoral Fracture treatment is to realign the bone, encourage rapid recovery, and help the child resume regular/daily activities, as early as possible. The age of the child usually determines, which treatment method is used:

Children up to a year old:

  • Pavlik harness: A Pavlik harness is a soft joint positioning device that helps keep the infant’s leg in a fixed and secure position. This orthopedic device is commonly used when treating newborn infants for hip dysplasia, hip disorders, and femur fractures

Children less than 4 years old:

  • Spica cast: If the Pavlik harness is ineffective, or if the child is older than six months, a spica cast may be required to treat the femur fracture. After the orthopedic surgeon realigns the bones, the child’s injured leg is placed in a specialized cast called spica cast, which is designed to immobilize the child’s leg. Spica cast is also known as a body cast

Children 5 to 10 years old:

  • Intramedullary nailing: During an intramedullary nailing procedure, once the bone is realigned, a specialized metal rod is placed within the bone marrow canal (intramedullary) of the femur. This medal rod is designed to hold the femur bone in its original position

Older children and adolescents:

  • Submuscular plating: Submuscular plating is a treatment method predominantly used for much older and larger children/adolescents. In this process, using x-ray images for guidance, the physician places a stainless steel plate under the muscles of the leg and across the fracture site. Using tiny incisions within the skin, screws are placed through the plate and bone, above and below the fracture. This is designed to immobilize the bone in its original position.
  • Open reduction and internal fixation (ORIF): Open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as plates, screws, or rods) is then used to stabilize the fractured bone under the skin
  • Open reduction and external fixation (OREF): Open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as plates, screws, or rods) is then used to stabilize the fracture, from outside the skin

How can Pediatric Femoral Fracture be Prevented?

Children should be trained to be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Pediatric Femoral Fractures include:

  • Individuals, who participate in any high-risk sports, should wear appropriate safety equipment to help prevent the possibility of such fracture
  • Wearing appropriate footwear (such as the proper shoe size), may help prevent accidents
  • Maintaining a healthy body weight can help avoid unnecessary pressure on the joints
  • Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with appropriate calcium-intake is recommended, even after a Pediatric Femoral Fracture
  • Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Pediatric Femoral Fracture? (Outcomes/Resolutions)

  • A majority of Pediatric Femoral Fractures heal without any serious complications. There is a complete recovery; children and adolescents regain full function of their leg, without any growth issues
  • Some children may require additional treatment and support, due to disproportionate leg length, improper angulation or irregular rotation of the healed bone, infections, and in rare cases, persistent fracture of the thighbone (nonunion)
  • Most of these additional complications can also be resolved with proper treatment and rehabilitation

Additional and Relevant Useful Information for Pediatric Femoral Fracture:

  • Child abuse is the most common cause of a Pediatric Femoral Fracture in children under the age of 1, which accounts for approximately 70% of such fractures
  • Child abuse is also a leading cause of thighbone fractures in children, between the ages of 1 and 4 years. However, the incidence is much less, within this age group
  • In adolescents, motor vehicle accidents (either in cars, bicycles, or as a pedestrian) are responsible for the vast majority (up to 90%) of femoral shaft fractures
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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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