paediatric
Pediatric Femoral Shaft Fracture
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 6-year-old boy is brought to the emergency department after falling from playground equipment. He is unable to weight bear and has obvious deformity of his left thigh. He is otherwise well with no head injury or other complaints. On examination, there is swelling and deformity of the left thigh. The limb is neurovascularly intact. Radiographs confirm a midshaft femoral fracture.
AP and lateral radiographs of the left femur in a 6-year-old child showing a transverse midshaft femoral fracture. There is approximately 1.5cm of overlap (shortening) and acceptable alignment. The fracture pattern is consistent with low-energy trauma. The physis is open. This fracture is suitable for flexible intramedullary nail (TENS) fixation given the child's age and fracture characteristics.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the age-based treatment algorithm for pediatric femoral shaft fractures.
Question 2 (5 marks)
What are acceptable alignment parameters and healing expectations?
Question 3 (6 marks)
Describe the technique for flexible intramedullary nailing (TENS).
Question 4 (5 marks)
When is spica casting appropriate and how is it applied?
Question 5 (4 marks)
What are the indications for rigid nailing and the precautions?
Question 6 (4 marks)
How do you assess for non-accidental injury?
Exam Day Cheat Sheet
Must Mention
- •Age-based algorithm (Pavlik/Spica/TENS/Rigid nail)
- •TENS: 40% canal width each nail = 80% total
- •Acceptable alignment varies by age
- •Overgrowth 1-2cm (ages 2-10)
- •Lateral trochanteric entry (NOT piriformis in open physis)
- •NAI: <3yr, non-ambulatory = high suspicion
Common Pitfalls
- •Wrong age algorithm
- •Piriformis entry
- •Wrong nail size
- •Missing NAI
- •Wrong alignment acceptance
- •Forgetting overgrowth