Functional Bracing for Pediatric Femoral Shaft Fractures

Functional femur bracing is an alternative to spica casting in toddlers and preschool-aged patients with femoral shaft fractures. Prefabricated braces can be applied at the bedside quickly with minimal training and without anesthesia. The braces are adjustable to allow optimal positioning of the hip in flexion and abduction, as well as alteration as needed based on fracture characteristics and behavior. Hook and loop straps at the waist and leg permit swelling management and hygiene. Hinges allow for early motion and ambulation. This paper discusses the indications, techniques, and recommended follow-up for functional bracing and illustrates clinical results. Historically, the gold standard for the treatment of femur fractures in children aged 2 to 5 was closed reduction and spica casting. Functional bracing eliminates the need for casting and anesthesia and allows for easy adjustment and patient hygiene. Early results of a randomized controlled trial show equivalent outcomes to spica casting in the treatment of femoral shaft fractures. Brace application involves adjustment of a prefabricated brace to fit the patient, appropriate analgesia and family education.