title: Pediatric femoral shaft fractures: treatment strategies according to age--13 years of experience in one medical center.
abstract: OBJECTIVE
  The objective of this study was to analyze our experience in treating femoral shaft fractures with different strategies, focusing on the first year after injury when the choice of method would have the greatest impact.
  
  
  METHODS
  We reviewed the medical records of all children treated for femoral shaft fractures in our institution between 1997 and 2010. They were divided according to therapeutic approach: spica cast, skin traction, titanium elastic nail (TEN), external fixator, intramedullary medullary nail (IMN), and plating.
  
  
  RESULTS
  The 212 patients included 150 boys and 62 girls (M/F ratio 2.4:1, mean age 5 years, range 0-16). The postoperative radiographic results demonstrated solid union in all patients, with no malunions. Of the 151 children in the spica cast group, 10 required re-manipulation and casting due to loss of reduction with unaccepted angulation, 10 had contact dermatitis, and 2 had fever and pressure sores. All 21 elastic nail group children underwent re-operation to remove the hardware: 3 had soft tissue irritation at the insertion points, and 3 had leg length discrepancy (LLD). Of the 14 external fixation patients, 4 had LLD, 1 had a pin tract infection, and 1 had a fracture through a pinhole after a fall. There were no complications in the 12 IMN patients, the 3 plating patients, or the 11 skin traction patients. LLD rates in the spica group were 10.5% higher compared to those in the control group (other treatment modalities) (P = .03).
  
  
  CONCLUSIONS
  TEN treatment was superior to spica casting for children who had reached an average age of 4 years.
authors.affiliation: Department of Orthopedic Surgery, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Sela
authors.forename: Oded
authors.initials: O
authors.lastname: Hershkovich
authors.forename: Nir
authors.initials: N
authors.lastname: Sher-Lurie
authors.forename: Amos
authors.initials: A
authors.lastname: Schindler
authors.forename: Uri
authors.initials: U
authors.lastname: Givon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002370:Casts, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013165:Splints / Q000009:adverse effects; D014143:Traction / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome