Children`s Orthopaedics

General guideline according to age

< 6 months

Palvik harness
Angulation & overlapping will remodel and overgrowth
Rotation will not self correct

< 5 years

Immediate hip spica cast in 90 degrees knee and hip flexion

5 - 10 years

Skin traction followed by hip spica cast

10 - 15 years

Screw & plate or elastic titanium nail

> 15 years

Intramedullary nail ( ILN or K nail )

Issues

Overgrowth

• At the physis not at the fracture site
• Due to hyperemia over the physis
• Also due to retraction of the complete circumferential tear of the periousteun to both end therefore stimulating the physeal growth ( initial trauma or operation )

So, recomended to let the bone overlaping < 2 cm due to this overgrowth phenomenan
But not every patient will overgrowth
Still not wrong to let the fracture end appose anatomically

The initial shortening will also equalize later on due to catch up growth

Acceptable angulation

Along joint motion
30 degrees
Lateral angulation
Less. 10 - 15 degrees

This entry was posted on Sunday, January 6th, 2008 at 2:43 pm and is filed under Femur Fracture. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.