Treatment of Pediatric Diaphyseal Femur Fractures

Publication Date: December 5, 2020
Last Updated: March 14, 2022

Recommendations

CHILD ABUSE

Strong evidence supports that children younger than thirty-six months with a diaphyseal femur fracture be evaluated for child abuse. (Strong)
Description: Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention.
6731

INFANT FEMUR FRACTURE

Limited evidence supported treatment with a Pavlik harness or spica cast for infants six months and younger with a diaphyseal femur fracture, because their outcomes are similar. (Limited)
Description: Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
6731

EARLY OR DELAYED SPICA CASTING

Moderate evidence supports early spica casting or traction with delayed spica casting for children age six months to five years with a diaphyseal femur fracture with less than a 2 cm of shortening. (Moderate)
Description: Evidence from two or more “Moderate” quality studies with consistent findings or evidence from a single “High” quality study for recommending for or against an intervention.
6731

ELASTIC INTRAMEDULLARY NAILS

Strong evidence supports the use of flexible intramedullary nailing to treat children age five to eleven years diagnosed with diaphyseal femur fractures. (Strong)
Description: Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention.
6731

ORIF PEDIATRIC FEMUR FRACTURES

Limited evidence supports rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing as treatment options for children age eleven years to skeletal maturity diagnosed with diaphyseal femur fractures, but piriformis or near piriformis entry rigid nailing are not treatment options. (Limited)
Description: Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
6731

PAIN CONTROL

Limited evidence supports regional pain management for patient comfort peri-operatively. (Limited)
Description: Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
6731

WATERPROOF CASTING

Limited evidence supports waterproof cast liners for spica casts are an option for use in children diagnosed with pediatric diaphyseal femur fractures. (Limited)
Description: Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
6731

Recommendation Grading

Overview

Title

Treatment of Pediatric Diaphyseal Femur Fractures

Authoring Organization

Publication Month/Year

December 5, 2020

Last Updated Month/Year

February 7, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Child

Health Care Settings

Ambulatory, Childcare center, Home health, Hospital

Intended Users

Physical therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D005264 - Femoral Fractures

Keywords

Pediatric Diaphyseal Femur Fractures

Source Citation

American Academy of Orthopaedic Surgeons. Treatment of Pediatric Diaphyseal Femur Fractures Evidence-Based Clinical Practice Guideline. www.aaos.org/pdffcpg. Published December 5, 2020.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
86
Literature Search Start Date
October 1, 2008
Literature Search End Date
April 6, 2020