SEPTEMBER 2012 |฀Volume฀35฀•฀Number฀9 773 n tips & techniques Section Editor: Steven F. Harwin, MD F emur fractures are com- mon injuries, accounting for 1.6% of all fractures in children and affecting 19 in 100,000 children annually in the United States. 1 Two peaks occur in the incidence of these fractures in children, with the first peak in toddlers af- ter a fall and the second peak in adolescents after a high- energy trauma. 2 Pediatric fe- mur fracture is the most com- mon orthopedic diagnosis among pediatric trauma pa- tients admitted to hospitals. 1 Acute management and stabilization of these fractures is controversial. Current initial management includes skeletal traction, skin traction, trac- tion splinting, and posterior splinting, all of which have advantages and disadvantages. Literature on the initial tempo- rizing management is limited. Skeletal traction in chil- dren is effective in the initial management of pediatric fe- mur fractures, yet the potential morbidity of placing a skel- etal traction pin is substantial. Physeal growth arrest follow- ing proximal tibial or distal femoral traction in children is a potential serious complica- tion. The psychological trauma of skeletal traction is also po- tentially detrimental. Skeletal traction has been shown to in- crease the pain medication and anxiolytic dose requirements and carries the morbidity of pin-site infections, as well as the risks associated with con- scious sedation. 3 Imprecise traction pin placement has been shown to increase the incidence of varus or valgus alignment of the fracture. 4 Skin traction has less mor- bidity compared with skeletal traction. However, the limited ability to pull a maximum of 5 to 10 lb of traction across the fractured limb reduces its ef- fectiveness in restoring axial alignment. Skin traction also carries the risk of skin blister- ing and sloughing, especially in patients with altered sensa- tion. In addition, skin traction makes patient transfers chal- lenging. Traction splinting using modern, commercially avail- able variations of the Thomas splint is commonly used in the field for transportation of femur fractures. Risks of traction splinting include skin breakdown on the foot and nerve stretch with peroneal nerve palsies. 5 These splints can also limit neurovascular examination sensitivity due to their compressive nature. Traction splints should not be used for more than 6 hours. Long posterior fiberglass or plaster splints are largely inef- fective for stabilizing femur fractures, especially if they are midshaft or more proximal (Figure 1). In the authors’ ex- perience, posterior splints do not provide the desired frac- ture stability or patient com- fort. Numerous studies have discussed the definitive treat- ment of these fractures, 3,4,6,7 Abstract: This article describes a novel splinting technique for the temporizing management of pediatric femur fractures. The J-splint is a reliable, simple, and rapidly applied splint that pre- vents many of the complications and pitfalls of other described temporizing measures, such as skeletal traction, skin traction, traction splinting, and posterior splinting. This technique of J-splinting femur fractures has low morbidity and provides many advantages in the temporizing management of pediatric femur fractures. Drs Daniels, Kane, and Born are from the Division of Orthopaedic Trauma, and Dr Eberson is from the Division of Pediatric Orthopaedics, Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Drs Daniels, Kane, Eberson, and Born have no relevant financial rela- tionships to disclose. The authors acknowledge Michelle Daniels for her illustration assistance. Correspondence should be addressed to: Christopher T. Born, MD, Divi- sion of Orthopaedic Trauma, Department of Orthopaedics, The Warren Alp- ert Medical School of Brown University, 2 Dudley St, MOC 200, Providence, RI 02905 (christopher_born@brown.edu). doi: 10.3928/01477447-20120822-05 Temporizing Management of Pediatric Femur Fractures Using J-splints Alan H. Daniels, MD; Patrick M. Kane, MD; Craig P. Eberson, MD; Christopher T. Born, MD