This guideline is specific for the assessment and management of femur fractures
Femoral shaft fractures are more common than other parts of the femur
Consider non-accidental injury in femoral shaft injuries in infants
Shock is never the result of a single femoral shaft fracture in children – look for another site of haemorrhage
Femur fractures account for approximately 1.5% of paediatric fractures
Incidence is most common in the 2 – 3 year age group and adolescence
Consider non-accidental injury. Complete an Injury Proforma form in children < 2 yrs (A3 folded sheet located in the Doctor’s offices)
Neurovascular examination should be performed regularly
Look for other injuries if the mechanism is due to a motor vehicle accident or there is concern for non-accidental injury
The most common mechanism of injury for early childhood is a fall resulting in a twisting injury or a direct blow
Sports and motor vehicle accidents are the most common mechanism of injury for adolescents
In infants, femoral shaft injuries should raise suspicion of non-accidental injury. A careful and detailed history should be taken in these cases. Do an injury proforma sheet for children < 2 years (A3 folded sheet located in the Doctor’s offices).
There is usually pain and swelling of the thigh with reluctance to move the hip and knee joints
Assess for neurovascular compromise and open wounds
In children, proximal femoral fractures (physeal, intertrochanteric and femoral neck fractures) are less common than femoral shaft fractures but have higher rates of complication (osseous necrosis)
All proximal femoral fractures should be referred to the Orthopaedic Team for further management
Slipped Upper (or Capital) Femoral Epiphysis (SUFE) usually presents in adolescents with a history of chronic hip or knee pain but may also present acutely with trauma
Management involves strict bed rest, analgesia and Orthopaedic Team referral for pinning. See Limp and Hip Pain.
Hip dislocation is uncommon in children but may be associated with fracture. Early referral to the Orthopaedic Team for reduction is important to reduce the incidence of osseous necrosis.
Shaft of Femur
All femoral shaft fractures should be referred to the Orthopaedic Team
Younger children will need traction +/- hip spica and older children may need intramedullary rods to stabilise the fracture
Adequate analgesia including femoral nerve block is important while awaiting Orthopaedic Team review
Traction splint should be applied once adequate analgesia has been given
Diazepam 0.2mg/kg orally is useful for muscle spasm and adjunct oral analgesia such as Pain Stop (combination paracetamol/codeine syrup) and Ibuprofen should be provided prior to transfer to the ward. See Analgesia.
Spiral fracture of femur in a 3 month old was a result of NAI – also note ‘Bucket Handle’ appearance of distal metaphysis
Transverse fracture of femur with displacement and shortening secondary to a MVA
Fractures of Femur Requiring Urgent Orthopaedic Referral
All fractures of the femur in children should be referred to the Orthopaedic Team
Urgent referral is needed for any fracture with neurovascular compromise
Referrals and follow-up
All femoral fractures in children are referred to the Orthopaedic Team and followed up in the Orthopaedic Fracture clinic. See Outpatient Clinics.