Treatment Options
- Immediate spica
- < 2 year
- Early Spica
- Skin traction followed by casting within 24 hours
- Two part cast, thigh first then corset
- Indicated
- < 80 lbs with stable fracture pattern
- Acceptable Reduction
- 10 mm shortening
- < 10 years old
- 15-20° varus valgus
- anterior bowing < 35°
- posterior bowing, 10-15°
- > 10 years old
- varus valgus – < 5-7°
- skeletal overgrowth is common 10-20 mm
- Skeletal Traction
- 90-90
- balanced traction with thomas sling
- usually < 12 years old
- subtrochanteric, supracondylar or unstable fracture
- Pin 2 cm above the growth plate
Surgical Options
Indications
- larger & older children
- bilateral femoral fractures
- floating knee
- polytrauma
- open fracture
- failure of closed treatment
External Fixation
- especially if bad soft tissue envelope
- can be used with partial weight bearing
IM Technique
- Rigid
- proximal growth arrest & AVN
- trochanteric approach
- Flexible | Nancy
- on each side of the metaphysis distally
Plating
- Especially if multitrauma, bilateral injury, ipsilateral tibial injury
- Require later plate removal
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.