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Plymouth Paediatric Orthopaedics

Lower Limb

Lower limb fractures are far less common than upper limb fractures. Treatment of these fractures varies dramatically depending on the fracture location and the child’s age.

Femoral fractures in children under 5 are usually treated in hip spica. This is a plaster that looks like a pair of trousers (see photo). It requires a general anaesthetic to apply, but not to remove. It is usually left on for between 4 and 6 weeks. Our occupational therapists can help with wider car seats and buggies. Between the ages of 5 and 12, flexible intra-medullary rods are used inside the bone to splint the fracture. The advantage is that children can start to mobilise earlier, but require an open operation to insert them. Over the age of 12 femoral fractures are more often treated with similar techniques used in adults – plates and screws, external fixators or adult femoral nails.

Tibial fractures can often be treated in an above knee plaster. If the fracture cannot be controlled in this manner, an operation to insert a plate and screws, external fixator or flexible rods may be required.

Ankle fractures in young children are very uncommon, as a result of their flexibility. They are more common in young teenagers who are approaching the end of their growth period. The fractures often occur through a partially fused growth plate, and require operative treatment – an open reduction and internal fixation with screws.

Foot fractures are very uncommon, and rarely require anything more than a plaster for a few weeks. Pelvic and acetabular fractures are thankfully extremely rare and usually seen in multiply injured patients.