Femur fracture (peds)

For adult patients see Femur fracture

Background

• Bimodal distribution
  • Toddlers: Most common mechanism is falls
  • Adolescents: High energy trauma such as MVA or Auto vs Ped
• Maintain high suspicion for child abuse (second most common child abuse-related fracture after humerus)

Clinical Features

• History of trauma
• Pain, point tenderness, deformity
• Inability to walk/bear weight

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Pediatric hip pain

• Acute rheumatic fever
• Developmental dysplasia of hip
• Femur fracture
• Juvenile idiopathic arthritis
• Legg-Calve-Perthes disease
• Septic arthritis of the hip (peds)
  • Lyme disease arthritis
• Slipped capital femoral epiphysis
• Transient (toxic) synovitis
• Osteosarcoma

Evaluation

• Assess for distal pulse, motor, and sensation
• Inspect skin for signs of open fracture
• X-ray femur

Management

• Ortho consult in ED
  • In general, femur fractures in children >6mo require surgical repair

Disposition

• Admit

See Also

• Child abuse
• Femur fracture