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Pediatric femoral shaft fracture

Key sources
The following summarized guidelines for the evaluation and management of pediatric femoral shaft fracture are prepared by our editorial team based on guidelines from the American Academy of Orthopaedic Surgeons (AAOS 2020; 2009), the American College of Radiology (ACR 2019; 2018), and the British Medical Journal (BMJ 2017).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging
As per ACR 2019 guidelines:
Obtain hip and pelvic X-ray as the initial imaging of the hip with acute pain, fall or minor trauma, and suspected fracture.
B
Obtain MRI of pelvis and affected hip without IV contrast or CT of pelvis and hips without IV contrast as the next imaging study for the evaluation of acute hip pain from a fall or minor trauma with negative radiographs and suspected fracture.
B
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2.Medical management

Pain management: consider offering regional pain management for patient comfort perioperatively.
C

3.Nonpharmacologic interventions

Harness/casting: consider offering treatment with either a Pavlik harness or spica cast in pediatric patients ≤ 6 months of age with a diaphyseal femur fracture.
C
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4.Therapeutic procedures

Nailing
Perform flexible intramedullary nailing for the treatment of pediatric patients 5-11 years of age with a d diaphyseal femur fracture.
A
Consider performing rigid trochanteric entry nailing, submuscular plating, or flexible intramedullary nailing as treatment options in pediatric patients aged 11 years to skeletal maturity. Do not perform piriformis or near piriformis entry rigid nailing.
C

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