Treatment of Pediatric Diaphyseal Femur Fractures
Publication Date: December 4, 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
American Academy of Orthopaedic Surgeons
Publication Month/Year
December 4, 2020
Last Updated Month/Year
August 29, 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
Methodology
Number of Source Documents
86
Literature Search Start Date
September 30, 2008
Literature Search End Date
April 5, 2020