Diaphyseal femoral fractures in children: should we change the present mode of treatment?

Three hundred thirty-nine diaphyseal fractures of the femur in 327 children were studied retrospectively. There were 196 boys and 131 girls, with a mean age of 5.59 years (range, 1 day-14 years). The majority of the children were < 6 years of age. In 67.8% of the children, the fracture was caused by a road traffic accident. Seventy-seven of the children had associated injuries. The minimum hospital stay was 15 days, and the maximum was 42 days (mean, 32.6 days). The most common site of fracture was at the middle third (N = 206), and 133 were the transverse type. The mode of treatment was balance skin traction in 146, skeletal traction in 72, hip spica in 22, internal fixation in 16, and external fixators in 5. The average follow up was 7.8 years. Complications were few. Our experience indicates that with a conservative mode of treatment, there is no risk of overgrowth, and a rotational malalignment of up to 20 degrees corrects during growth. We believe that diaphyseal fractures of the femur in children can be safely managed nonoperatively and economically, contrary to the present advocacy of operative treatment. The operative mode of treatment should be used in selected cases.