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New Guideline For The Treatment Of Pediatric Diaphyseal Femur Fractures

July 22, 2009

The American Academy of Orthopaedic Surgeons’(AAOS) Board of Directors approved a new clinical practice guideline for the treatment of pediatric diaphyseal femur fractures. Diaphyseal (the shaft of a long bone) fracture of the femur (the bone in the thigh) is a very common childhood injury.

There are several accepted treatment options for femur fracture, a thighbone injury occurring in an average of 19 out of 100,000 kids each year. However, there has not previously been a thorough examination and recommendation outlining the evidence-based best practice recommendations. Therefore, this new guideline can help physicians in three ways, by:

  • Outlining the best-known practices depending on the age and size of the child;
  • Assuring the most thorough review of all evidence-based outcomes of treatment, by reviewing more than 42 years of published research; and
  • Highlighting what research work still needs to be done to better predict and navigate future care and research.
  • “Our treatment recommendations include not just best practices, but a heightened level of attention to the child’s social and emotional state as well. For instance, though casting and traction still is an effective treatment, when we believed it was a comparable medical option, this guideline outlined flexible nailing for an internal splint, which significantly reduced hospital stay time, thus getting the child back into her school, family and social routines,” said Dr. Ernest L. Sink, an AAOS work group Vice Chair on this guideline and practicing pediatric orthopaedic surgeon from The Children’s Hospital in Aurora, Colorado.

The pediatric diaphyseal femur fracture clinical practice guideline presents:

  • the results of a systematic review of published studies from 1966 to October 1, 2008, on the treatment of isolated diaphyseal femur fractures in children*;
  • 14 specific recommendations;
  • the results of the Academy’s commitment to developing more evidence-based outcome methods and resulting guideline recommendations for its members and the orthopaedic surgery community; and
  • guidance for appropriately trained surgeons and all qualified physicians considering treatment of isolated diaphyseal femur fractures in children.
  • “Treating a child’s fractured femur is a very successful endeavor, with a high likelihood of good outcomes. If you are a parent, you can be relieved to know that thousands of hours of peer review went into the development of this guideline, and if you are a physician, you can trust that your peers have given these treatment options and outcomes the most comprehensive review.” said Dr. Sink.

In addition to providing practice recommendations, the guideline also highlights gaps in the literature and areas that require future research. It also is intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations.

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American Academy of Orthopaedic Surgeons




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