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The aim of this study was to compare the modern treatments for femoral fractures in children to see if they have any advantages over traditional treatments. The modern treatments are mainly operative with the objective is to get the children mobilising early and to minimise the time spent in hospital. We studied 66 children who had sustained a traumatic femoral shaft fracture, over a six-year period with a minimum follow up of two years. A protocol using early hip spicas for under 5 year olds, flexible intramedullary nails for over 5 year olds, and external fixation for the polytrauma cases was started in 1999. Over a three-year period there were 25 children who sustained a fracture (Early active group). These were prospectively reviewed with a minimum follow up of 24 months. The outcome measures being, length of hospital stay, degree of mal-union, range of movement of the hip and knee, leg length discrepancy, pain and functional restrictions. This modern patient group was compared with all the fractures in the three years prior to the new protocol commencing. This group were treated usually with in patient traction (Traditional group). There were 41 children in this group who had sustained a fracture between 1996 and 1999. The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the early active group (p less than 0.001). If we exclude the children who were severely injured with multiple injuries the mean stay is 29 nights and 10 nights (p less than 0.001). There was no significant difference in the mal-union rate between the two groups. Very few had pain and at 2 years they all had good clinical and functional results. The only significant complication rate was with the fractures that were treated with an external fixator. These were mainly pin site infections. In our population there has been a 40% reduction in the incidence of femoral fractures over the six-year period for which we have no explanation. These modern treatments have resulted in a shorter hospital stay that has many advantages for the child and family as well as financial savings.

Early active treatment of femoral shaft fractures in children—A proposed protocol