Send them to the gallows! Paediatric femur fracture.

A disturbing case I saw recently of a 6 month old baby who’s toddler brother was jumping on the bed and landed across the baby’s leg – snapping the femur clean in half.
paed_femur
Disturbing on many levels, including the obvious “is that really how it happened” question that I felt obliged to ask, but deferred due to the level of parental distress; disturbing as I could easily see my 2.5yr old daughter doing the same thing to my 10 month old son, (how would I explain that, I wondered…) and my inability to think of adequate analgesic options quickly (we ended up with IV fentanyl, after consulting the anaesthetist, and after I failed the IV twice and the serendipitous Paeds Reg walking by helped me get IV access), and disturbing because I assumed the baby would go straight to theatre, wrongly explained this to the parents, and then was educated by the Ortho team that they actually manage these in traction – in a device disturbingly called “gallows traction”.

Here’s a link to some images of gallows traction

Thankfully a rare enough injury, but thought I’d share the management tip in case you ever see one, as the management is non-operative in younger patients, (traction if displaced, spica if undisplaced), operative in older kids.

Here’s a nice summary over at Wheeless Online.

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2 Responses to Send them to the gallows! Paediatric femur fracture.

  1. JenCross001 July 23, 2012 at 6:00 am #

    I’ve always loved giving intranasal fentanyl whilst trying to get an iv in.:D

  2. Andy B July 23, 2012 at 6:08 am #

    Thanks Jenny
    I love it too, but all the protocols I’d seen said “don’t give under 12 months”, which I queried the anaesthetist about and he put me on track by reminding me it’s no worse than IV fentanyl in children under 12 months!
    On the topic of I/N fentanyl, I’ve started using it as an adjunct to N2O sedation, pre-IV insertion, prior to x-ray for kids with farctures, burns cases and various other ad-hoc applications. Does anyone else have any tips for when intranasal fentanyl is helpful?

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