Dear Ashok

The surgical treatment of femoral shaft fracture in a 2 years old child is an unusual indication. When and if necessary, I fix with retrograde flexible nails (ESIN). The plate and screws and/or rigid trochanteric entry nails don t have indication (the plate and screws need be removed - 2nd surgery - and the refracture rate is very high) and rigid trochanteric entry nails causes avascular necrosis of the femoral head. Blount said (100 years ago): in this age we can accept 3.O cms of shortening with good results and nowadays , 2013, this is true . Best regards

Dear Nelson, Thank You. I completely agree with you.

But, yesterday we received a Case of 2 years old patient. Previously, the operation was done in different hospital for the fracture of shaft of femur. Now, she came to our hospital 1year later for implant removal with the Compression Plate in situ. So, I was wondering what could have been the indications for Plating in a 1-2 years old child ??

Dear Ashok

In my opinion plating does not have indication in a femoral shaft fracture in a 1-2 years old child. Best regards

Thank you.

In my opinion there is no indication of a plate fixation in a shaft femur fracture in a 2 years old patient. An spica cast is adequate in most cases. Remodeling is exceptional in this type of fracture. Shortening of the fracture is needed because of the hypermetabolic response in the bone that will eventually catch up with the contralateral side. An anatomic reduction at this age will result in a longer limb at the end of growth. Not to mention the 2 operations that the child needs, one to put the plate and one to remove it. I had one patient plated at age 3 in another center, anatomic reduction, at age 15 consulted because of a 5 cm overgrowth of the operated femur. The options we had was to lengthen the contralateral femur, or do an acute shortening of the operated one. Unusually choice: the patient wanted the acute shortening and was 100% active in 3 months instead of 6-8 months with a lengthening procedure with a circular frame.

Dear Carlo, thank you.

Plating has no place in the surgical treatment in a 2-year-old child with femoral fracture. Flexible intramedullary nails are the treatment of choice.

Dear Panayot,

I do agree.

Thank you.

Plating is long gone as treatment of shaft fractures in a child. Flexible intramedulary nails are the chosen treatment for this category of fractures. There are diameters that can accomodate all femoral canals.

I feel plating for femur # in 02 yrs old child is not indicated in usual cases. The only indication can be of corrective osteotomy fixation or non union fractures.

In a 2 year old child with femoral fracture there is no indication of a fixation plate ORIF. In my experience the synthesis with ESIN is indicated in patients older than 2 years because at this age with spica cast (well supported by the patient) you get a great remodeling in a few weeks. it is important to get the correct rotation and make the plast with hip and knee  in slight flexion to prevent procurvatum. The etherometry is present but not predictable exactly. This does not justify an approach with fixation plate. In case of pluriframmentate or open fractures, type "gun-shot", can find a place external fixation, but are very borderline cases...

There is not any indication to operate a child 2 y old with a femoral femuru using plates and screws. It is a big medical mistake.

There is not also indication to use elastic titanium nails in this age. A spica cast will treat perfect the child. We must only avoid any varus angulation in the cast, The cast must remoonved after 4 weeks. We have to know also that there is no need for any physiotherapy.