Surgical Versus Conservative Management of Paediatric Femur Fractures – A Comparative Study

Open Access

Abstract

Background: Paediatric femoral shaft fractures represent a major cause of morbidity in children, with management varying widely between conservative and surgical approaches. Determining the most suitable treatment requires evaluation of demographic characteristics, fracture patterns and clinical outcomes within specific healthcare contexts. Objective: This study compared the treatment outcomes between conservative and surgical management of paediatric femoral shaft fractures in a tertiary center in Bangladesh. Methods & Materials: This comparative observational study was conducted in the Department of Orthopedic Surgery, Ideal Health City, Rangpur, Bangladesh, from January 2021 to December 2024. A total of 100 children aged 2–14 years with diaphyseal femoral fractures were included and assigned to conservative (n = 50) or surgical (n = 50) groups. Data were collected from clinical records and radiographs. Descriptive statistics summarized baseline variables and group comparisons were performed using t-tests and chi-square tests, with significance set at p ≤ 0.05. Results: Surgical treatment was more frequently performed in older children and those sustaining high-energy trauma. Transverse fractures predominated in the conservative group, whereas oblique and spiral patterns were more common surgically. Surgical treatment demonstrated significantly shorter time to radiographic union, reduced hospital stays and earlier full weight-bearing. Limb length discrepancy and malunion occurred more frequently with conservative treatment, while infection and re-intervention were observed only in surgically managed children. Conclusion: Surgical fixation offers faster recovery and fewer alignment-related complications in older children, whereas conservative treatment remains appropriate for younger patients with stable fractures.