Femur fracture (peds)

For adult patients see Femur fracture

Background

• Bimodal distribution
  • Toddlers: Most common mechanism are falls
  • Adolescents: High energy trauma such as MVA or Auto vs Peds
• High suspicion for child abuse

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 limp

Hip Related

• 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

Other Causes of Limping

• Developmental dysplasia
• Fracture
  • Toddler's fracture
  • Tillaux fracture, adolescent
• Neoplasm:
  • Leukemia
  • Ewings
  • Osteogenic sarcoma
  • Metastatic neuroblastoma
• Osteomyelitis
• Myositis
• Other:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

Evaluation

• Assess for distal pulse, motor, and sensation
• Inspect skin for signs of open fracture
• XR
  • Femur AP and lateral

Management

• Ortho consult in ED