Pediatric Femoral Fracture Management Techniques

Femoral fractures in children present unique challenges owing to the balance between achieving stable fixation and preserving the open growth plates. Non-operative methods such as spica casting remain effective for young children with simple, diaphyseal fractures, offering the advantages of minimised surgical trauma and early discharge. As age and weight increase, surgical options predominate, including elastic stable intramedullary nailing (ESIN), commonly with titanium elastic nails (TEN), which allows early mobilisation and rapid union with minimal scarring. Subtrochanteric and proximal femoral fractures often require more rigid constructs such as locking compression plates, particularly in older or heavier children. Treatment selection is guided by fracture pattern, patient age, body habitus and expected compliance, with recent advances focusing on optimising implant removal, minimising complications in obese patients and refining fixation strategies for complex metaphyseal and proximal diaphyseal injuries. A comprehensive classification system underpins standardised decision-making and facilitates multicentre research.

Research from Nature Portfolio

Recent analysis of internal fixation removal in paediatric bone cysts highlights the influence of implant residence time, extra-osseous nail length and the use of bone graft on extraction difficulty. Children over approximately 12 years of age and those with nails in situ beyond ten months exhibited significantly higher rates of challenging removal procedures. These findings underscore the need for careful planning of implant indwelling intervals and may inform guidelines for ESIN removal timing to reduce operative complexity.

Pediatric Femoral Fracture Management Techniques publication trend

The graph below shows the total number of articles in pediatric femoral fracture management techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Elastic stable intramedullary nailing (ESIN): A minimally invasive technique using flexible nails inserted into the medullary canal to stabilise long bone fractures while preserving growth plate integrity.

Titanium elastic nailing (TEN): A form of ESIN employing titanium alloy nails that provide flexible internal fixation and allow early mobilisation.

Hip spica cast: A rigid cast extending from the torso to one or both lower limbs, often used in young children to immobilise femoral fractures non-operatively.

Locking compression plating (LCP): A rigid fixation method using contoured plates with threaded screw heads that lock into the plate, offering stable support in complex or proximal fractures.

Subtrochanteric region: The segment of the femoral shaft immediately below the trochanters, where fracture biomechanics demand specific fixation strategies.

References

1. Factors which can influence elastic stable intramedullary nailing removal in healed bone cysts in children. Scientific Reports (2024).
2. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthopaedica (2016).
3. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. Journal of Children's Orthopaedics (2010).
4. Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children. Journal of Orthopaedics and Traumatology (2011).
5. Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures. Medicine (2018).
6. Complications with flexible nailing of femur fractures more than double with child obesity and weight >50 kg. Journal of Children's Orthopaedics (2009).