Background: There is a paucity of literature regarding the timing of treatment for pediatric femur fractures.
Purpose: The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function.
Methods: Pediatric patients presenting with femoral shaft fractures from 01/01/2010-01/01/2021 were identified using the Database at a single level one Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function was collected. Patients were then divided into two groups; the early intervention group underwent treatment within 24 hours of admission versus the delayed group, which underwent treatment after 24 hours. Patients with neuromuscular disease, pathological fracture, slipped capi- tal femoral epiphysis, non-ambulatory, less than 6 months old, or had follow-up of <8 weeks post-treatment were excluded. Chi-square and unpaired students t-tests were used to compare outcomes. A p-value ≤ 0.05 was used as the threshold of statistical significance.
Results: Of the 169 cases reviewed, 137 met inclusion criteria. The mean age was 8.0±5.0 (6 months-16 years). The average follow-up time was 1.4±1.4 years. Thirty-two (19%) patients did not meet inclusion criteria and were excluded from the study. One hundred and twenty-two (89%) patients were in the early intervention group versus 15 (11%) in the delayed intervention group. There were no statistically significant differences between the early and the delayed arms in regard to time to union, quality of final reduction, and return to baseline function.
Conclusion: The findings of this study support that the timing of surgical intervention of femoral shaft fractures in the pediatric population is not correlated to time to union and final function. Clinically, prompt treatment of pediatric femoral shaft fractures should not supersede medical methods of resuscitation and likely has no bearing on final outcome.
