The femur is the most important bone of the lower limb. The surgical strategy clearly changes with the child's age and weight: there is no single right answer.
Good healing can often be achieved with a hip spica cast after reduction under anaesthesia. Femoral remodelling is generous at this age and tolerates small alignment imperfections well.
Surgical stabilisation tends to be the choice, because a spica cast would be poorly tolerated and would leave the bone unprotected for too long. Techniques change with weight and fracture type.
Two elastic nails inserted from the distal femur and advanced up to the fracture site. Minimally invasive technique allowing early partial weight-bearing.
Diaphyseal fractures in school-age children and adolescents, with weight compatible with elastic nail stability.
It is the most common technique for paediatric femur between 6 and 12 years. Nails are removed in a planned second operation.
Long plate inserted with minimally invasive technique under the muscles, fixed with percutaneous screws. More stable than ESIN.
Heavier adolescents, multifragmentary fractures, situations where ESIN does not offer enough stability.
Metal nail passed inside the medullary canal, locked with distal and proximal screws. Similar to the adult technique.
Adolescents close to or at skeletal maturity, with no significant risk to the growth plates.
Entry point and technique are chosen to minimise risk to the femoral head.
After realignment, one or more screws are inserted under the skin to stabilise the fracture without opening it.
Stable or well-reducible fractures needing focal fixation, as an alternative to elastic nails or more rigid techniques.
A cast immobilising pelvis and lower limb. With or without surgery, after reduction under anaesthesia.
Young children with stable or well-reducible fractures, or in specific phases after surgery.
A femur fracture — operated or not — always has a major impact on daily life. Mobility, hygiene, sleep, school and transport are all affected. A meaningful part of the visit is dedicated to building a realistic plan for the first weeks.
Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.
Book a visitContent for general informational purposes only. It does not replace a medical evaluation.