Conservative management of a displaced femoral shaft fracture in an 8 year-old child with excellent functional outcome: a case report

Flexible stable intramedullary nailing with titanium elastic nailing system (TENS) is commonly accepted as a preferred treatment in diaphyseal fractures of femur in children aged 6-12 years. However, in cases with significant anaesthetic risk due to medical comorbidities conservative management can be considered. An eight year old boy from a rural area in Kerala with an unrepaired congenital atrial septal defect sustained a displaced, closed mid-shaft fracture of the right femur following a road traffic accident. TENS was recommended for the fracture but surgical intervention was not accepted by the parents because of concerns regarding anaesthesia-related cardiac risk. Hence, the child was managed conservatively with skin traction followed by hip spica cast application. Serial radiographs were then taken which showed evidence of delayed union with progressive callus formation, attaining near-complete union by eight months, with residual angulation and approximately 2 cm limb shortening. Even though these radiological findings were present, child attained an excellent clinical outcome, with painless full weight-bearing, normal hip and knee range of motion, and the ability to squat comfortably. This case shows that conservative management of paediatric femoral shaft fractures may be appropriate in meticulously selected high-risk patients. Functional recovery and patient safety may be considered as a superior factor than radiographic perfection, especially in children with ampleremodelling potential.