title: Algorithm for the management of femoral shaft fractures in children.
abstract: OBJECTIVE
  Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment.
  
  
  METHODS
  Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF).
  
  
  RESULTS
  Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in both types of treatment. Patients treated with EF had shorter limb length discrepancy compared with SC. There were no reports of re-fracture. We found a higher familiar satisfaction in patients treated with EF.
  
  
  CONCLUSIONS
  An algorithm for the management of femoral shaft fractures in the pediatric population is proposed. Results on the study population gave raise to a satisfactory clinical and radiological results.
authors: Section of Orthopaedics, University of Messina, Messina, Italy.
authors: I
authors: I
authors: Sanzarello
authors: E
authors: E
authors: Calamoneri
authors: L
authors: L
authors: D'Andrea
authors: M A
authors: MA
authors: Rosa
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000465:Algorithms; D001265:Athletic Injuries / Q000628:therapy; D001858:Bone Nails; D016723:Bone Remodeling; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D015444:Exercise; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007870:Leg Length Inequality / Q000453:epidemiology / Q000209:etiology; D008297:Male; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
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