Differences between pediatric and adult femoral fractures

Significant differences between femoral fractures occurring in children and those occurring in
adults include the following:

Pediatric femoral fractures heal rapidly because of a biologically active periosteum and
abundant vascularity; the formation and subsequent remodeling of the callus are rapid in
children who have sustained femoral fractures

Proximal femoral fractures in children are the result of high-energy trauma, in contrast to
comparable fractures in the elderly, which may result from a trivial trauma such as a fall

Transepiphyseal separation is an injury seen only in the skeletally immature

The transcervical and cervicotrochanteric fractures seen in children are associated with a
higher incidence of avascular necrosis and coxa vara

Cervicotrochanteric and intertrochanteric fractures can lead to premature closure of the

trochanteric apophysis and coxa valga

Children have much greater potential for healing and remodeling after proximal femoral
fractures

Deformities after these injuries in children often progress with age (particularly when the
growth plate is injured)

Remodeling of the residual deformities after malunion of femoral shaft fractures leads to
resolution of the deformities; a malunion is most likely to remodel if the deformity is
close to a joint, is in the plane of normal motion at the neighboring joint, and is in a
younger child; however, remodeling does not normally correct the rotational malunion

Femoral overgrowth after fracture leading to limb length discrepancy and femoral growth
disturbances after fracture are problems seen exclusively in children

Anatomic reduction is not required for regaining preinjury function; it is more important
to restore the alignment of fragments with respect to one another

The presence of the ossification centers modifies the choice of internal fixation for these
fractures in children; to prevent iatrogenic growth disturbances, the treatment chosen
must avoid injury to the trochanteric apophysis and the distal femoral physis

Isolated femoral fractures usually do not necessitate a blood transfusion, because the
blood loss is not significant; these patients can be treated with routine monitoring [5]

Children with multiple trauma associated with femoral fractures are at lower risk for
pulmonary complications; furthermore, the timing of fracture stabilization, unlike the
timing in adults, does not affect the risk of pneumonia or respiratory distress syndrome [6]