The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 92, Issue 8

Evidence-Based Orthopaedics | July 21, 2010

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Pediatric Diaphyseal Femur Fracture

Mininder S. Kocher, MD, MPH; Ernest L. Sink, MD; R. Dale Blasier, MD; Scott J. Luhmann, MD; Charles T. Mehlman, DO, MPH; David M. Scher, MD; Travis Matheney, MD; James O. Sanders, MD; William C. Watters, III, MD; Michael J. Goldberg, MD; Michael Warren Keith, MD; Robert H. Haralson, III, MD, MBA; Charles M. Turkelson, PhD; Janet L. Wies, MPH; Patrick Sluka, MPH; Rich McGowan, MLS

View Disclosures and Other Information

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DeRoyal Industries, Medtronic Sofamore Danek, Stryker Spine). In addition, one or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet, ConMed Linvatec, Smith and Nephew Endoscopy, OrthoPediatrics).

Disclaimer: This clinical guideline was developed by an AAOS physician volunteer Work Group and is provided as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. It is not intended to be a fixed protocol as some patients may require more or less treatment. Patient care and treatment should always be based on a clinician's independent medical judgment given the individual clinical circumstances.

The complete AAOS guideline can be found at http://www.aaos.org/research/guidelines/PDFFguideline.pdf

J Bone Joint Surg Am, 2010 Jul 21;92(8):1790-1792. doi: 10.2106/JBJS.J.00137

5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Article

Comments (0)

text A A A

Extract

Summary of Recommendations

Figures in this Article

Introduction

Summary of Recommendations

The following is a summary of the recommendations in the AAOS' clinical practice guideline, The Treatment of Pediatric Diaphyseal Femur Fractures (PDFF). This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will also see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility. This summary of recommendations is not intended to stand alone.

We recommend that children younger than thirty-six months with a diaphyseal femur fracture be evaluated for child abuse.

Level of Evidence: II
Grade of Recommendation: A

Treatment with a Pavlik harness or a spica cast are options for infants six months and younger with a diaphyseal femur fracture.

Level of Evidence: IV
Grade of Recommendation: C

We suggest early spica casting or traction with delayed spica casting for children age six months to five years with a diaphyseal femur fracture with less than 2 cm of shortening.

Level of Evidence: II
Grade of Recommendation: B

We are unable to recommend for or against early spica casting for children age six months to five years with a diaphyseal femur fracture with greater than 2 cm of shortening.

Level of Evidence: V
Grade of Recommendation: Inconclusive

We are unable to recommend for or against patient weight as a criterion for the use of spica casting in children age six months to five years with a diaphyseal femur fracture.

Level of Evidence: V
Grade of Recommendation: Inconclusive

When using the spica cast in children six months to five years of age, altering the treatment plan is an option if the fracture shortens greater than 2 cm.

Level of Evidence: V
Grade of Recommendation: C

We are unable to recommend for or against using any specific degree of angulation or rotation as a criterion for altering the treatment plan when using the spica cast in children six months to five years of age.

Level of Evidence: V
Grade of Recommendation: Inconclusive

It is an option for physicians to use flexible intramedullary nailing to treat children age five to eleven years diagnosed with diaphyseal femur fractures.

Level of Evidence: III
Grade of Recommendation: C

Rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing are treatment options for children age eleven years to skeletal maturity diagnosed with diaphyseal femur fractures, but piriformis or near piriformis entry rigid nailing are not treatment options.

Level of Evidence: IV
Grade of Recommendation: C

We are unable to recommend for or against removal of surgical implants from asymptomatic patients after treatment of diaphyseal femur fractures.

Level of Evidence: IV
Grade of Recommendation: Inconclusive

We are unable to recommend for or against outpatient physical therapy to improve function after treatment of pediatric diaphyseal femur fractures.

Level of Evidence: V
Grade of Recommendation: Inconclusive

Regional pain management is an option for patient comfort perioperatively.

Level of Evidence: IV
Grade of Recommendation: C

We are unable to recommend for or against the use of locked versus non-locked plates for fixation of pediatric femur fractures.

Level of Evidence: IV
Grade of Recommendation: Inconclusive

Waterproof cast liners for spica casts are an option for use in children diagnosed with pediatric diaphyseal femur fractures.

Level of Evidence: III
Grade of Recommendation: C

Topics

femoral fractures ; pediatrics ; clinical practice guideline ; levels of evidence

First Page Preview

View Large

Username

Password

Access for Patients

Forgot Password?

Have a subscription to the print edition?

Not a Subscriber?

Buy this Article

Get online access for 30 days for $35

New to JBJS?

Subscribe to the online edition for 30 days for $75

Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.

Have a subscription to the print edition?

Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.

Activate your online account now

Forgot your password?

Enter your username and email address. We'll send you a reminder to the email address on record.

Username:*

Email Address:*

Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
by your institution, please contact you librarian or administrator for username and password information. Institutional
administrators, to reset your institution's master username or password, please contact subs@jbjs.org

References

Accreditation Statement

These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

CME Activities Associated with This Article

Submit a Comment

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

* = Required Field

Comment Author(s) * (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
PDF
Email

Recipient(s) will receive an email with a link (good for 5 days) to 'American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Pediatric Diaphyseal Femur Fracture'.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*

Separate multiple email address with semi-colons (up to 5).

Subject:* 's The Journal of Bone & Joint Surgery: 'American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Pediatric Diaphyseal Femur Fracture'
Subject for your email.

Message:

(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The Journal of Bone & Joint Surgery, Inc. (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to Journal of Bone & Joint Surgery, Inc.'s Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The Journal of Bone & Joint Surgery Inc.'s Privacy Policy for further information.

Copyright © The Journal of Bone & Joint Surgery Inc. All rights reserved.
Share
Get Citation

Mininder S. Kocher, Ernest L. Sink, R. Dale Blasier, Scott J. Luhmann, Charles T. Mehlman, David M. Scher, Travis Matheney, James O. Sanders, William C. Watters, III, Michael J. Goldberg, Michael Warren Keith, Robert H. Haralson, III, Charles M. Turkelson, Janet L. Wies, Patrick Sluka, Rich McGowan; American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Pediatric Diaphyseal Femur Fracture. The Journal of Bone & Joint Surgery. 2010 Jul;92(8):1790-1792.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © The Journal of Bone and Joint Surgery, Inc.
Rights & Permissions
Article Alerts

Processing your request... Please Wait.
Submit a Comment