Diaphyseal Femur Fractures Guidelines

Updated: Jun 29, 2020
  • Author: Bart Eastwood, DO; Chief Editor: William L Jaffe, MD  more...
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ACS COVID-19 Guidelines for Triage of Orthopedic Patients

On March 24, 2020, the American College of Surgeons (ACS) published COVID-19 guidelines for triage of orthopedic patients. The general recommendations for all surgical cases include the following [90] :

  • Provide appropriate and timely surgical care based on sound surgical judgment and availability of resources
  • Consider nonoperative management whenever it is clinically appropriate for the patient
  • Consider waiting on results of COVID-19 testing in patients who may be infected
  • If possible, avoid emergency surgical procedures at night when staff may be more limited
  • Aerosol generating procedures (AGPs) increase risk to the health care worker; for patients who are or may be infected, AGPs should only be performed while wearing full PPE including an N95 mask or powered, air-purifying respirator (PAPR) that has been designed for the operating room 

During phase II, hospitals have many COVID-19 patients, intensive care unit (ICU) and ventilator capacity are limited, or supplies are limited or the COVID-19 trajectory within the hospital is in a rapidly escalating phase. For trauma patients during this phase, the guidelines recommend restricting orthopedic procedures to new fractures, acute traumatic injury, nonunions, malunions and infections.

During phase III, hospital resources are all routed to COVID-19 patients, there is no ventilator or ICU capacity, or supplies have been exhausted. For trauma patients during this phase, the guidelines recommend restricting orthopedic procedures to new fractures, quad tendon rupture, patellear tendon rupture and acute changes of a chronic injury with inability to function.


AAOS Guidelines for Pediatric Diaphyseal Femur Fractures

American Academy of Orthopaedic Surgeons (AAOS) guidelines for treatment of diaphyseal femur fractures in children include the following [91] :

  • Strong evidence supports that children younger than 36 months with a diaphyseal femur fracture be evaluated for child abuse
  • Moderate evidence supports early spica casting or traction with delayed spica casting for children age 6 months to 5 years with a diaphyseal femur fracture with less than 2 cm of shortening
  • Limited evidence supports treatment with a Pavlik harness or a spica cast for infants 6 months and younger with a diaphyseal femur fracture, because their outcomes are similar
  • Limited evidence supports the option for physicians to use flexible intramedullary nailing to treat children age 5-11 years diagnosed with diaphyseal femur fractures
  • Limited evidence supports rigid trochanteric entry nailing, submuscular plating, and flexible intramedullary nailing as treatment options for children age 11 years to skeletal maturity diagnosed with diaphyseal femur fractures, but piriformis or near piriformis entry rigid nailing are not treatment options
  • Limited evidence supports regional pain management for patient comfort perioperatively
  • Limited evidence supports waterproof cast liners for spica casts are an option for use in children diagnosed with pediatric diaphyseal femur fractures