Pediatric Thighbone Fracture

The largest and strongest bone in the body, the thighbone (femur) can break when a child suffers a sudden forceful impact. Common causes of pediatric femur fractures include:

• Falling on the playground.
• Taking a hit in contact sports.
• Being in a car crash.
• Child abuse.

A serious injury, a broken thighbone might be obvious by severe pain and disability. Your child may be unable to walk or have limited range of motion, pain made worse by movement and swelling. A child with a thighbone fracture may also have other serious injuries.

Diagnosis and treatment

Call 911 or take your child to the doctor right away if you think he or she might have a broken thighbone. Explain exactly how the injury occurred and tell the doctor if your child had any disease or other trauma before it happened. The doctor will give your child an anesthetic or pain relief medication and carefully examine the leg including the hip and knee. The pattern of the fracture may be one of several. The pieces of bone may be aligned or out of alignment (displaced), closed (skin intact) or open (piercing the skin). Your doctor will need X-rays to see the pattern of the break. Your child's healthy leg may also be X-rayed for comparison. An orthopaedic surgeon may check for any damage to the growth area (growth plate) near the end of the femur, which enables the child's bone to grow. If needed, surgery may restore the growth plate's function and regular X-rays may be taken for many months to track the bone's growth.

Reduction and immobilization

To treat a child's thighbone fracture, the pieces of bone are realigned and held in place for healing. Your doctor will choose appropriate treatments depending upon your child's age/weight, the type of fracture, how the injury happened, whether the bone broke the skin, if there was also an injury to the child's head and other factors.

General guidelines for reduction while under a general anesthetic:

• Your doctor may be able to manipulate certain thighbone fractures back into place from the outside (closed reduction). In some cases, it may helpful to put the child's leg in a weight and counterweight system (traction) before the bones are realigned.

• To treat more complicated injuries, the doctor may need to surgically realign the bone with or without implants.

General guidelines for immobilization:

• A young child may be casted for a femur fracture or an external or internal device may be used if the break was displaced.
• Adolescents usually need external or internal devices for a femur fracture.

Treatment methods

• Traction and spica casting: Your child stays in the hospital for several weeks with his or her leg in a traction device. When the thighbone fracture begins to heal, your child gets a plaster or fiberglass hip cast (spica cast) to immobilize the leg in the correct position.
• Early spica cast: In certain cases, infants and small children can be fitted with a spica cast immediately or within 24 hours of hospitalization.
• External device: An external frame immobilizes your child's fracture, anchored by surgical pins placed above and below the fracture site, with pin care done at home.
• Internal devices: Your child's broken thighbone is immobilized internally with a rod, nailing system or plate secured directly in the bone.

When the immobilization device is removed, your child may need to do rehabilitation exercises to restore range of motion and flexibility. The doctor may want to see your child again after the thighbone fracture heals to make sure healing is satisfactory.