Open Femur Fracture with Soft Tissue Loss

  • Cheryl Lawing
  • Adam Margalit
  • Michael Ain
Living reference work entry


High-grade open femur fractures in pediatric patients are high-energy injuries and 70% of patients have associated injuries. Despite the pediatric nature of the patient, these wounds are at high risk for infection, which can be as high as 50% in type III fractures. Thus, thorough debridement and timely administration of prophylactic antibiotics are essential. Fixation type largely depends on the age of the patient with consideration of the soft tissue injury. Internal fixation with intramedullary fixation, open reduction internal fixation (ORIF), or percutaneous fixation have been shown to have faster time to union than external fixation. These fractures are much slower to heal than closed pediatric femoral fractures, with full union taking potentially up to 32 weeks.

References and Suggested Reading

  1. FLOW Investigators, Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, Heels-Ansdell D, Schemitsch EH, Anglen J, Della Rocca GJ, Jones C, Kreder H, Liew S, McKay P, Papp S, Sancheti P, Sprague S, Stone TB, Sun X, Tanner SL, Tornetta P 3rd, Tufescu T, Walter S, Guyatt GHA (2015) Trial of wound irrigation in the initial management of open fracture wounds. N Engl J Med 373(27):2629–2641CrossRefGoogle Scholar
  2. Gonzalez-Herranz P, Burgos-Flores J, JM Rapariz JA, Lopez-Mondejar JG, Ocete S (1995) Amaya. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg Br 77(2): 262–266PubMedGoogle Scholar
  3. Hauser CJ, Adams CA, Eachempati SR (2006) Council of the Surgical Infection Society Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence based guideline. Surg Infect 7:379–405CrossRefGoogle Scholar
  4. Hutchins CM, Sponseller PD, Sturm P, Mosquero R (2000) Open femur fractures in children: treatment, complications, and results. J Pediatr Orthop 20(2):183–188PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryShrinez Hospital for ChildrenTampaUSA
  2. 2.Department of Orthopaedic SurgeryJohns Hopkins UniversityBaltimoreUSA

Section editors and affiliations

  • Eric D. Shirley
    • 1
  1. 1.Pediatric Orthopaedic AssociatesAltantaUSA

Personalised recommendations