Public Release:  American Academy of Orthopaedic Surgeons approves new guideline for the treatment of pediatric diaphyseal femur fractures

American Academy of Orthopaedic Surgeons

ROSEMONT, Ill. -- The American Academy of Orthopaedic Surgeons'(AAOS) Board of Directors approved a new clinical practice guideline for the treatment of pediatric diaphyseal femur fractures. Diaphyseal (the shaft of a long bone) fracture of the femur (the bone in the thigh) is a very common childhood injury.

There are several accepted treatment options for femur fracture, a thighbone injury occurring in an average of 19 out of 100,000 kids each year. However, there has not previously been a thorough examination and recommendation outlining the evidence-based best practice recommendations. Therefore, this new guideline can help physicians in three ways, by:

  • Outlining the best-known practices depending on the age and size of the child;
  • Assuring the most thorough review of all evidence-based outcomes of treatment, by reviewing more than 42 years of published research; and
  • Highlighting what research work still needs to be done to better predict and navigate future care and research.

"Our treatment recommendations include not just best practices, but a heightened level of attention to the child's social and emotional state as well. For instance, though casting and traction still is an effective treatment, when we believed it was a comparable medical option, this guideline outlined flexible nailing for an internal splint, which significantly reduced hospital stay time, thus getting the child back into her school, family and social routines," said Dr. Ernest L. Sink, an AAOS work group Vice Chair on this guideline and practicing pediatric orthopaedic surgeon from The Children's Hospital in Aurora, Colorado.

The pediatric diaphyseal femur fracture clinical practice guideline presents:

  • the results of a systematic review of published studies from 1966 to October 1, 2008, on the treatment of isolated diaphyseal femur fractures in children*;
  • 14 specific recommendations;
  • the results of the Academy's commitment to developing more evidence-based outcome methods and resulting guideline recommendations for its members and the orthopaedic surgery community; and
  • guidance for appropriately trained surgeons and all qualified physicians considering treatment of isolated diaphyseal femur fractures in children.

"Treating a child's fractured femur is a very successful endeavor, with a high likelihood of good outcomes. If you are a parent, you can be relieved to know that thousands of hours of peer review went into the development of this guideline, and if you are a physician, you can trust that your peers have given these treatment options and outcomes the most comprehensive review." said Dr. Sink.

In addition to providing practice recommendations, the guideline also highlights gaps in the literature and areas that require future research. It also is intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations.

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For more information or to schedule an interview with an expert spokesperson on this guideline, treatment options for pediatric orthopaedic injuries or dozens of other musculoskeletal conditions and innovative treatments, call the media relations department at the AAOS at 847-384-4034.

*"Children", according to the work group's criteria, was defined as those not having reached skeletal maturity.

About femur fractures, information for parents and caregivers:

The thighbone (femur) is the largest and strongest bone in the body.

A child with a thighbone fracture is unable to walk, will have limited range of motion, and the pain will be made worse by movement and swelling. A child with a thighbone fracture may also have other serious injuries. The femur can break when a child experiences a sudden forceful impact. Take your child to the emergency room right away if you think he or she has a broken thighbone. Explain exactly how the injury occurred. Tell the doctor if your child had any disease or other trauma before it happened. The doctor will give your child pain relief medication and carefully examine the leg including the hip and knee.

The American Academy of Orthopaedic Surgeons:

With more than 35,000 members, the American Academy of Orthopaedic Surgeons (www.aaos.org or www.orthoinfo.org) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality musculoskeletal health. An orthopaedic surgeon is a physician who treats the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

AAOS Guidelines: This clinical practice guideline was developed by an AAOS physician volunteer workgroup based on a systematic review of the current scientific and clinical information and accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician's independent medical judgment, given the individual patient's clinical circumstances.

This guideline and evidence report were exclusively funded by the American Academy of Orthopaedic Surgeons who received no funding from outside commercial sources to support the development of this guideline. All panel members gave full disclosure of conflicts of interest prior to participating in the development of this guideline. This guideline and evidence report received no financial support from industry sponsors.

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