Treatment of femoral shaft fractures in the growing phase. From hip spica casts to elastic stable intramedullary nailing

There are two essential age peaks in pediatric femoral shaft fractures. The first peak concerns children between the ages of 2-4 years and the second peak is around puberty. In young children femoral shaft fractures may occur due to a relatively minor accident but the accident mechanism in older children usually involves high-velocity trauma. In children that are not yet at the walking stage, child abuse must always be excluded as the cause of the fracture. Treatment of femoral shaft fractures up to the age of 3 years is usually conservative by means of a cast or extension therapy, whereas in older children this is the domain of elastic stable intramedullary nailing (ESIN).