Childrens Fractures

Ten years ago, a 15-year-old with a broken thighbone (femur) would probably be treated with:  

• Traction in a hospital for several weeks.  
• Followed by several months in a body cast.  

Today, the same child may be treated with:  

• Surgery and a few days in the hospital.  
• Followed by going home and back to school with use of crutches or a wheelchair for the rest of recovery.  

Quality of life is the difference. A child's broken thighbone will heal just as well with either surgical or non-surgical treatment. Quality of life is the difference.

"We're no longer thinking just about how the bone heals," said James H. Beaty, MD, professor of orthopaedics at the University of Tennessee-Campbell Clinic in Memphis. "We're considering the pros and cons of various options. This includes shortening the time spent in the hospital, rehabilitation time, time out of school and impact on the family. We're involving the family more in the decision-making process." Dr. Beaty participated in a media briefing on children and adolescents. It was held at the 2002 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Orthopaedists started weighing "quality of life" factors. They re-evaluated how broken thighbones were traditionally treated. In the past, treatment usually involved long hospital stays and recovery times.

Now, doctors decide how to treat children's fractures on a case-by-case basis. They try to keep children out of the hospital as much as possible and allow them to be mobile as soon as they can be.  

Treatment Options

Orthopaedists generally divide childrens' fractures into three categories:  

• Those that heal well only with surgery. For example, a child would probably need surgery to successfully treat a broken hip, growth plate or joint surface.  
• Those that heal equally well with surgery or with immobilization. For example, a child may or may not need surgery to treat a broken thighbone.
• Those for which surgery is not usually necessary. For example, a child would probably not need surgery to treat a broken forearm.  

Most childrens' fractures can be treated without surgery. But in the group of fractures that can be treated either way, "we're beginning to zero in on differences in outcome between the options," Dr. Beaty said.

The child's age also affects treatment decisions. A broken thighbone that heals in three months in a teenager would heal in only three to four weeks in a preschooler.

Treatment Options: Surgical

Surgery is recommended much less frequently in a younger child.  

June 2004

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