Edited by Amy Steele, David Evans - 7/1/2021
Descriptors
Stable vs. length unstable fracture patterns (fracture length > 2x bone diameter)
Exam Pearls
Ask about mechanism, if patient is under 3 years old, raises red flag of nonaccidental trauma (NAT) Transverse fractures raise red flag of NAT Medical comorbidities: OI, osteopenia, bone tumor
Thigh pain and inability to walk after fall or MVC Gross deformity, shortening, swelling
Workup
Radiographs: AP and lateral of the femur, ipsilateral AP/lat of the knee and hip to rule out associated injuries
Other imaging: None
Labs: None
Other: None
Management
Need for acute intervention: Yes, immobilization without reduction
Weight-bearing and range of motion: Non-weight bearing
Type of immobilization: Posterior slab splint as needed for comfort in younger population, may place in skin/bucks traction for older children
Admission or discharge status: Admission for management (nonoperative and operative)
Anticoagulation: None usually indicated/age dependent
Antibiotics: Perioperative unless open fracture
Surgical Indications
Absolute: Depends on age and fracture pattern whether casting (< 5 years old usually nonoperative intervention), > 5 years old start to thinking about operative intervention