Tribhuwan Narayan Singh Gaur1 , Tariq Mahmood2 , Ankush Bhargava3 , Dilip Moolchandani4 , Ankit Sharma5 , Harish Rao6 , Mrudul Shah7

Femoral shaft fractures are the most common major pediatric injuries managed by the Orthopaedics surgeon. They represent approximately 1.6% of all bony injuries in children. Males are affected more frequently than females with regards to age; the distribution is bimodal with peaks at age of 2 and 12 years. Advancement in c, increasing number of fast moving vehicles has been accompanied by an increase in the number and severity of fractures in the paediatric age group. The incidence of femoral fractures in children comprises 20 per 100,000 yearly in the United States and Europe.1 The treatment of femoral shaft fractures in the pediatric population remains controversial. The child age often directs the management. Non operative treatment options include functional treatment for the very young, pavlic harness, skin or skeletal traction, and spica casting. Operative treatment options include closed reduction and external fixation, open reduction and internal plate fixation, closed reduction and minimally invasive plate osteosynthesis (MIPO), and closed reduction and intramedullary nailing with either flexible or rigid nails. Intramedullary nail fixation of pediatric long bone fracture, particularly femoral shaft fracture, has revolutionized the care and outcome of these complex injuries. Nailing is associated with a high rate of union and a low rate of complications. Traditional management of paediatric femoral shaft fractures has been in the form of traction and casting and immobilization in spica cast as a standard treatment for all femoral shaft fractures in children, and femoral fractures ranked high in terms of duration of hospitalization. Indications for surgical management were few and included children with associated injuries like head injury, abdominal injury or compound fracture with extensive soft tissue trauma. The aversion to treat femoral shaft fractures in paediatric age group patients operatively is aptly reflected in statement given by Blount” the operation is unnecessary, however and as such must be condemned. It introduces the hazard of an unnecessary anesthetic, unnecessary exposure of bone ends, and trauma to the entire marrow cavity of the femur. There is no reason for doing it. Moreover one postoperative osteomyelitis in a lifetime is enough to cure a surgeon of a casual attitude toward open reduction.” Complications such as limb length discrepancy, torsional angular deformities, pressure sores, nerve palsies, soiling of the skin and, breakage of the plaster, joint stiffness were noticed with spica cast management even after proper precautions to add to these were the psychosocial implications of spica cast treatment and its complications, with separation of child from his environment and the difficulties in taking care of a child in spica. On account of the above complications, in the last few decades,