Pediatric emergency medicine trisk 3497 3497
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Injuries of the Femur and Knee
Injuries of the Shaft of the Femur
CLINICAL PEARLS AND PITFALLS
Nonaccidental trauma should be investigated in nonambulatory
children with femur fractures.
Isolated femur fractures in children rarely result in hemodynamically
significant blood loss, unlike in adults.
Femur fractures in older children and adolescents are most commonly sustained
from high-energy mechanisms (e.g., motor vehicle collisions, pedestrian–motor
vehicle impact) resulting in multisystem trauma involving other organ injuries. In
younger children, however, less force is necessary to cause a femur fracture. A
femur fracture usually presents with pain and swelling of the thigh. All patients
with a femur fracture should have urgent orthopedic consultation for further
management. AP and lateral radiographs of the femur, including the hip and knee,
should be obtained. The extremity should be immobilized with a posterior leg
splint until definitive care is obtained. Femoral shaft fractures occur in all
pediatric age groups, but have different mechanisms of injury, complications, and
treatments based on age.
Birth to 2 Years Old. Femur fractures in this young age group are typically a
result of a slow twisting motion or a direct blow ( Fig. 111.38 ). Nonaccidental
trauma should always be considered in this age group, especially in the
nonambulatory child. Treatment is usually with a Pavlik harness for infants or
spica casting.
Two to 10 Years Old. Treatment is initially with traction or splinting, and then
spica casting for children less than 6 years old and intramedullary nailing for
those 6 to 11 years old. These fractures can result in the long-term complications
of leg length discrepancy, malrotation, and malunion.
Adolescents. Femur fractures in this age group can be initially stabilized with
traction splints in the field or a posterior leg splint until orthopedic consult is
obtained ( Fig. 111.39 ). Management is with surgical stabilization with internal
fixation to improve alignment and promote an earlier return to activity.
