Management trends and outcomes of femur fractures in children with cerebral palsy: a systematic review and meta-analysis

This review aims to evaluate the treatment and outcomes of femur fractures in children with cerebral palsy (CP). Femur fractures are common in this population because of physiological and mechanical factors. Treatment approaches vary based on functional status and fracture characteristics. Medline, Embase, Central, and Scopus databases were systematically searched for studies investigating outcomes following femur fractures in children aged 0-18 with CP who received surgical or nonsurgical treatment. Primary outcomes were fracture location, ambulatory status, treatment types, and complications. A meta-analysis was conducted when data homogeneity permitted, using mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Of 213 screened articles, seven were included, reporting 335 femur fractures in 258 patients. Most fractures occurred in the distal femur (52%) followed by mid-diaphyseal fractures (32%). Treatment varied by ambulatory status and fracture location, with 60% managed nonoperatively, typically in nonambulatory patients and for distal fractures. Nonoperative treatment, mainly spica casting, showed higher malunion rates (29%) and complications like pressure sores (11%). In contrast, operative treatment, preferred for proximal and mid-diaphyseal fractures, resulted in lower malunion rates in nonambulatory children (7%; P = 0.02) but had risks of postoperative pneumonia (6%) and surgical site infection (13%). Outcomes indicated improved healing and function with operative treatments in ambulatory children. Femur fractures in children with CP require individualized treatments based on the patient's fracture type and ambulatory status. Future studies should incorporate fracture mitigation metrics, functional outcomes, and caregiver impact to inform optimal patient-centered care.