Fractures of the femoral shaft in children.

A series of 133 fractures of the shaft of the femur in children (during the first 12 years) is discussed. The injury is much more common in boys. The highest incidence is in 3-year-old children. A gentle reduction is desirable and anaesthesia is rarely necessary. In the age group under consideration ½ in. of shortening in reduction is desirable; angulation should be avoided. Initial immobilization in younger children on Bryant's traction and in older children on a Thomas' splint has been found satisfactory. The application of a plaster spica after 2 or 3 weeks allows the child to return home and in this way saves hospital beds. Physiotherapy is not required. Complications should be avoided particularly with good nursing care but regular observation for vascular impairment (particularly after traffic accidents) is necessary. The management of this injury is usually uncomplicated and provides good experience for junior medical staff under supervision.