Pediatric Femur Fracture Registry

NCT ID: NCT03211546

Last Updated: 2025-08-29

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 322 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2018-03-14
• Study Completion Date: 2024-06-10

Brief Summary

Prospective data collection and evaluation of complete data sets will be performed in the course of routine clinical care of a cohort of consecutive patients (children up to 16 years old) presenting with an isolated femur shaft fracture. Data will be collected during follow-up visits at 3 to 6 weeks, 3, 6, 12 and 24 months, with additional follow-up visits as needed or dictated by individual practice. Final follow-up will be at 24 months, unless a patient requires additional follow-up or another intervention to address an unfavorable outcome (e.g. malalignment, nonunion, limb length discrepancy) noted at the 24 month follow-up visit.

Detailed Description

There is limited evidence about the comparative effectiveness of different treatments for pediatric femur fractures. The most common method used for isolated femur shaft fractures of children older than 5 years of age is elastic stable intramedullary nailing (ESIN). It is thought to be the ideal indication for children up to the age of 10 to 12 and it is the most commonly employed method of internal fixation in this age group, but other treatments include external fixation, plating, other forms of flexible or rigid intramedullary nailing and non-operative options such as spica casts or traction. In children under the age of 5 non-operative methods are believed to work well with few complications. Imperfect alignment is more acceptable because of the tremendous remodelling potential in young growing children. Internal fixation is believed to be unnecessary as it is more invasive, with some risk of complications and likely need for a second surgical procedure to remove it. Biomechanical properties are different in this age group. Consequently, operative treatment of these fractures is generally not recommended in children under the age of 3 according to the German guidelines (www.awmf.org), not under the age of 5 in the American guidelines (www.aaos.org); and in Great Britain, surgical management in preschool children is restricted to polytrauma and complex injuries (www.nice.org.uk).

Despite these recommendations and the general acceptance of non-operative treatment for younger children , a survey of clinical practice in Germany revealed that 50% of children under the age of 3 years are treated with ESIN, because some surgeons believe that patients seem less comfortable when treated with traction or spica casting and might experience a higher rate of loss of reduction. Consequently, the use of ESIN for fractures in preschool children has become more prevalent in the last years.

Similarly, there is wide variation in the preferred management of femoral shaft fractures in older children, with little evidence about the comparative effectiveness of different treatments for pediatric femur fractures. There is an imperative to collect prospective data to generate higher quality evidence.

The purpose of this proposed registry is to collect the clinical outcomes (fracture healing & patient reported outcomes and complications) of the treatment of isolated femur shaft fractures in children up to skeletal maturity. Additionally, health economic aspects will be evaluated to give possible recommendations from a health economic perspective.

Conditions

Femoral Shaft Fracture

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Femoral shaft fracture

Patients (children up to 16 years old) diagnosis of isolated closed femur shaft fracture (3.2-D) and open distal physis. Treatment strategies will follow standard of care (routine) procedures, either conservative (non-surgical) treatment or surgical treatment.

Conservative (non-surgical) treatment

Intervention Type: PROCEDURE

Spica cast Traction Traction and spica cast

Surgical treatment

Intervention Type: PROCEDURE

Elastic Stable Intramedullary Nailing (ESIN) Conventional locking intramedullary nail Plating External fixation

Interventions

Conservative (non-surgical) treatment

Spica cast Traction Traction and spica cast

Intervention Type: PROCEDURE

Surgical treatment

Elastic Stable Intramedullary Nailing (ESIN) Conventional locking intramedullary nail Plating External fixation

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Age less than 16 years of age at the time of the injury
• Open distal physis of the femur
• Diagnosis of isolated closed femur shaft fracture (3.2-D)
• Willingness and ability of the patient/parents/legally responsible care giver to participate in the clinical investigation including imaging and FU procedures as standard of care in each clinic
• Willingness and ability of the parent(s) to support the patient in his/her study participation
• Ability of parents to understand the content of the patient information / ICF and participation in the clinical investigation
• Signed ICF by patient and/or parent(s) according to local policies and regulations

Exclusion Criteria

• Polytraumatized patient
• Closed distal physis of the femur
• Pathologic fractures and fractures in patients with metabolic bone disease, osteogenesis imperfecta, neuromuscular disorder, endocrinologic disease or other conditions influencing the bony structure
• Participation in any other medical device or medicinal product study within the previous month that could influence the results of the present study

• Maximum Eligible Age: 16 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

AO Innovation Translation Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Peter P. Schmittenbecher, Prof.

Role: PRINCIPAL_INVESTIGATOR

Kinderchirurgische Klinik, Klinikum Karlsruhe

Unni G. Narayanan, Prof.

Role: PRINCIPAL_INVESTIGATOR

The Hospital for Sick Children, Toronto

Locations

Boston Children's Hospital

Boston, Massachusetts, United States

Medical University Hospital of Graz

Graz, , Austria

BC Children's Hospital

Vancouver, British Columbia, Canada

IWK Health Centre

Halifax, New Scotland, Canada

Children's Hospital of Eastern Ontario (CHEO)

Ottawa, Ontario, Canada

The Hospital for Sick Children

Toronto, Ontario, Canada

Universitätsklinik Dresden

Dresden, , Germany

University Medicine Göttingen (UMG)

Göttingen, , Germany

Altonaer Kinderkrankenhaus GmbH

Hamburg, , Germany

Städt. Klinikum Karlsruhe

Karlsruhe, , Germany

University of Leipzig

Leipzig, , Germany

University Hospital Tübingen

Tübingen, , Germany

Inselspital

Bern, , Switzerland

Childrens Hospital Zurich

Zurich, , Switzerland

Countries

United States; Austria; Canada; Germany; Switzerland

Other Identifiers

PedFemFx

Identifier Type: -

Identifier Source: org_study_id