Emergency Medicine, Ömer Halisdemir University Medical School, University Research and Education Hospital, Niğde

The second most frequent fracture affecting the lower leg in children is a fracture of the femoral diaphysis. After high-energy traumas, they take place. Over the past ten years, surgical intervention has gained popularity as a way to improve patient compliance and prompt mobilisation.

Our goal in doing this study was to raise awareness of the need for safeguards by providing a case study of trauma that could cause major, long-term disabilities in paediatric patients.

The second most frequent fracture affecting the lower extremity in children is a fracture of the femoral diaphysis (20-26/100000 children each year). Children experience 1-2% of fractures from these types of fractures [1-3]. In older children, surgical treatment has gained popularity over the last ten years to avoid the negative effects of long-term immobilisation, improve patient compliance, and allow for early mobilisation while non-operative techniques like the Pavlik harness, skeletal or skin traction, and pelvipedal plaster are preferred in younger children [4]. Among the surgical treatment alternatives are plate-screws and rigid or elastic nail applications. Closed, minimally invasive, or open techniques can be used to carry out these applications [5, 6]. We described the case of a 5-year-old patient who had a fracture of the femur distal diaphysis following a motorbike accident.

After a motorcycle accident, a five-year-old boy was examined in the emergency room alongside his elder brother. The following were his vital signs: 106/65 blood pressure, 105 heart rate, 99 saturation, and 36.6 fever. His biochemical and hemogram results were both normal. He suffered no more trauma. The patient with an isolated femoral distal diaphysis fracture sought orthopaedic advice. He was admitted to the hospital by an orthopaedic consulting doctor. He entered the operating room. The plate-screw system was used to fixate during surgery. Without incident, the patient was released from the hospital.

Traumas, pathological bone disorders, recurrent pressures, or child maltreatment can all cause paediatric femoral diaphysis and distal femoral fractures [7]. In our situation, the fracture was discovered as a result of a motorbike accident, a high-energy traffic accident. Numerous authors have discussed issues with femoral shaft fractures in school-aged children (5–15 years of age), including joint stiffness from prolonged immobilisation, a delayed return to normal activities, and poor reduction from insufficient fixation in the use of pelvipedal plaster, which was more frequently used in the past [8, 9]. As a result, there is debate regarding how best to treat femoral shaft fractures in this age range [8–10]. However, there has been a significant rise in the use of surgical therapeutic techniques.

The major goals of treatment for paediatric femoral diaphysis fractures are to facilitate fixation and preserve the blood supply and epiphyseal lines. Intramedullary nails are well-suited for these uses in terms of application and design [11]. They also have important benefits like preventing fracture hematoma and preventing muscle and periosteum damage because to closed reduction [11, 12].

In their extensive series of 123 cases, Ligier et al. found skin irritation and necrosis in 13 patients, deep infection in 1 patient (due to accompanying risk factors: paraplegic patient, spread of urinary infection), but they did not see any patients experience implant failure and require additional surgery. They came to the conclusion that physiological and satisfactory fixation using an elastic nail [13].In our situation, intramedullary nailing was performed, and the patient was successfully discharged. According to several papers, early surgery for femoral fractures reduces the risk of complications [12]. In conclusion, since massive bone fractures can happen in young patients following high-energy trauma like a motorcycle collision, it should be against the law for children to ride motorcycles or to do so without safety gear.

Conflict of interest: The authors have not disclosed any conflicts of interest.

1. Hedström EM, Svensson O, Bergström U, Michno P. Epidemiology of fractures in childrenandadolescents. ActaOrthop.2010; 81:148-153.

2. Heideken J, Svensson T, Blomqvist P, et al. Incidenceandtrends in femurshaftfractures in Swedishchildrenbetween 1987 and 2005. J Pediatr Orthop. 2011; 31:512-519.

3. Schalamon J, Dampf S, Singer G, et al. Evaluation of fractures in childrenandadolescents in a level I traumacenter inAustria. J Trauma. 2011; 71:E19-25.

4. Carey TP, Galpin RD. Flexibleintramedullary nail fixation of pediatricfemoralfractures. ClinOrthopRelatRes. 1996;332:110-118.

5. Kuremsky MA, Frick SL. Advances in thesurgicalmanagement of pediatricfemoralshaftfractures. CurrOpin Pediatr.2007; 19:51-57.

6. Uçar BY, Gem M, Bulut M, et al. Titaniumelasticintramedullarynailing: closedor mini-openreduction? ActaOrthopBelg. 2013; 79:406-410.

7. Doğan M, Bozkurt M, Karaca S, Altıngöz H, & May H. Çocuk Femur Cisim Kırıklarının İnkorporePelvipedal alçı ile Tedavisi,2004.

8. Martinez AG, Carroll NC, Sarwark JF, et al. Femoralshaftfractures in childrentreatedwithearlyspicacast. J Pediatr Orthop. 1991; 11:712-771.

9. Pollak AN, Cooperman DR, Thompson GH. Spicacasttreatment of femoralshaftfractures in children-theprognosticvalue of themechanism of injury. J Trauma. 1994; 37:223-229.

10. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elasticstableintramedullary nail fixation of pediatricfemoralfractures, and how toavoidthem. J Pediatr Orthop.2004; 24:363-369.

11. Saseendar S, Menon J, Patro DK. Treatment of femoralfractures in children: is titaniumelasticnailing an improvementoverhipspicacasting? J Child Orthop. 2010; 4:245-251.

12. Güzel Y, Güvenç K, Bilge O, Toker S, & Mustafa YELP. Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients. Dicle Medical Journal. 2016; 43(2):224- 228.

13. Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elasticstableintramedullarynailing of femoralshaftfractures in children. J Bone JointSurgBr. 1988; 70:74-77. Volume 2 | Issue 1 | 2021 3jc

Dolanbay Turgut. a young child who sustained a fractured femoral diaphysis in a motorcycle accident. Insights of Clinical and Medical Images 2022.