Child Orthopedics

Frequently Asked Questions

My six-month-old son is a regular acrobat. He can twist and turn out of my arms like you wouldn't believe. He was on the changing table and took a dive. I grabbed him by the leg and his thigh bone broke but at least I saved him from crashing onto his head. Fortunately my pediatrician knows what he's like or I might have been accused of child abuse (at least that's what she told me). The question now is how to treat him. He's at the age where he could still be put in a harness instead of a cast. But he's so active, will a harness hold him? What do the experts recommend?

Treating diaphyseal femur fractures with a special harness called a Pavlik harness is an option for infants up to age six months. Diaphyseal femur fracture refers to a break in the long shaft of the thigh bone. The harness holds the hips and knees in a bent and separated position until healing takes place. This can take five to six weeks. Studies are limited in comparing treatment for this problem but it does appear that results are better the younger the child is (up to three and a half months old). The use of a waist-high spica cast is the other option. There can be some problems from the cast rubbing on the leg but it does hold the very active child still. Comparing outcomes between the Pavlik harness and the spica cast shows similar results. So you may really be looking at what would work best for your child's size, severity of fracture, your living situation, and your stress level. Each treatment option comes with pros and cons. Since your pediatrician knows your child well, you may want to go over the various issues, factors, and potential complications of the various treatment options before making the final decision. Whichever route you choose, follow-up X-rays will be taken. Should there be any change in the status of the fracture site, treatment can be changed.

Mininder S. Kocher, MD, MPH, et al. Treatment of Pediatric Diaphyseal Femur Fractures. In Journal of the American Academy of Orthopaedic Surgeons. November 2009. Vol. 17. No. 11. Pp. 718-725.

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