From the Research
The recommended management for a 12-year-old with a non-displaced femoral shaft fracture typically involves surgical fixation with flexible intramedullary nails (FINs), also known as titanium elastic nails (TENs). This approach is preferred over conservative management with spica casting for this age group due to better outcomes and reduced complications, as supported by the most recent and highest quality study 1.
Key Considerations
- The procedure involves inserting two flexible titanium or stainless steel nails in a retrograde fashion from the distal femur, avoiding the growth plates.
- Post-operatively, the patient should be non-weight bearing for 4-6 weeks, followed by progressive weight bearing as tolerated with physical therapy.
- Pain management should include scheduled acetaminophen (15 mg/kg/dose every 6 hours, not exceeding 3000 mg/day) and ibuprofen (10 mg/kg/dose every 6 hours) for the first few days, transitioning to as-needed dosing.
- Regular follow-up with orthopedics at 2 weeks, 6 weeks, 3 months, and 6 months is essential to monitor healing and ensure proper alignment.
Rationale
The preference for TENs over spica casting in this age group is based on the systematic review and meta-analysis by 1, which demonstrated that TENs are superior to traction and hip spica for femoral fractures in patients younger than 16 years old, with better outcomes in terms of union time, sagittal and coronal angulations, and malalignment. This approach provides stable fixation while allowing early mobilization, reducing the risk of muscle atrophy, joint stiffness, and psychological impact of prolonged immobilization that would occur with casting, while also respecting the open growth plates that would contraindicate adult-style rigid intramedullary nailing.
Additional Considerations
While other studies, such as 2, 3, 4, and 5, provide valuable insights into the management of femoral fractures in children, the study by 1 is the most recent and highest quality, providing a comprehensive comparison of TENs and spica casting in patients under 16 years old. Therefore, its findings take precedence in guiding the management of a 12-year-old with a non-displaced femoral shaft fracture.