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Open Reduction & Internal Fixation of Distal Femoral Fractures in Children

What causes femur fractures in children?

Distal femur fractures in children can stunt growth of the leg by injuring the growth plate in the bone. An open reduction and internal fixation fastens the thigh bone pieces together with hardware, encouraging the bone to heal correctly and hopefully avoiding a stunted leg.

The femur, commonly known as the thigh bone, is the longest and strongest bone in the human body. It forms the upper part of the leg. Your child’s femur can fracture into two or more pieces after a sudden, forceful trauma.

Femur fractures that occur to the part of the femur near the knee (distal femur) are known as distal femoral fractures. Because the distal femur has a growth plate, any fracture in this part of the femur may stunt its growth, shortening the affected leg.

The most common cause of distal femur fractures in infants under aged under one year is child abuse. Child abuse is also a leading cause of femur fracture in children between one and four years old. In adolescents, motor vehicle accidents and falls are the major causes of femur fractures.

What are open reduction and internal fixation of distal femoral fractures in children?

Over the past couple of years, surgical treatment has been shown to reduce the hospital stays of children with femur fractures and decreased their early disability. Hence, it is increasingly preferred by doctors over the conventional methods for fixing femur fractures in children.

Open reduction and internal fixation (ORIF) is a commonly used surgical treatment for bone fractures, including the femur.  

ORIF places the pieces of the broken femur together and allows healing of the fracture. This is done using special artificial hardware to hold the bone pieces in the correct position.

When is open reduction and internal fixation of femur fractures done in children?

Your child is likely to need ORIF of the femur if  they have any of the following fractures:

  • Displaced femur fractures (the trauma displaces the broken pieces of the femur) that have shortened more than 3 cm
  • Open fracture (part of the femur breaks through the skin)
  • Femur has broken into more than two pieces 

How is open reduction and internal fixation of distal femoral fractures performed?

  • The surgery is done by an orthopedic surgeon, a doctor specializing in treating diseases of the muscles and bones.
  • Your child will be given general anesthesia that makes them sleep throughout the procedure. 
  • After cleaning the affected area with an antiseptic solution, the surgeon will make a cut (incision) through the skin and muscles of the thigh until he can see the femur. 
  • The surgeon will align the broken pieces of the femur (open reduction).
  • Next, the surgeon will attach the pieces of the femur with the help of screws, wires, nails, pins or metal plates (internal fixation). This secures the aligned pieces of the broken femur in place.
  • The muscles around your child’s thigh will be sutured closed and bandaged.


Emotional trauma is best described as a psychological response to a deeply distressing or life-threatening experience.
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What happens after open reduction and internal fixation of distal femoral fractures in children?

  • Your child will be shifted to the surgical ward.
  • Generally, the child can resume a normal diet right from the next day after surgery.
  • Your child will be given painkillers for several days. 
  • Your child’s legs will be wrapped in special support wear known as a spica cast that prevents the operated leg from moving. 
    • This is essential for the healing of femur. 
    • The spica cast typically needs to be changed every six weeks for around three to six months.
  • Depending on the extent of the injury, your child might be discharged within three to seven days.
  • Daily cleaning and changing the dressings of the wound is necessary to speed its healing.
  • Protect your child’s wound from water by tying plastic around their leg during washing.
  • Your surgeon may order X-rays of the operated leg at regular intervals to assess healing of the fracture. 
  • Fractures heal more rapidly in children than that in adults. Routine activities and playing usually help children return to normal within a few weeks to months.

What are the risks of open reduction and internal fixation of distal femoral fractures in children?

All surgeries carry some risks. The risks of ORIF of femoral fractures in children include:

  • Shortening of the operated leg
  • Malunion (bone healing out of alignment, leading to abnormal bony growth)
  • Nonunion (persisting bone fracture)
  • Abnormal rotation of the healed femur
  • Bending of the healed femur

Further treatment in subsequent years can usually resolve all these problems.

Medically Reviewed on 7/16/2020


Medscape Medical Reference

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