Subjective (Information from parents/guardians):
Date of visit
Reason for visit (initial presentation, follow-up)
History of present illness:
Mechanism of injury (fall, motor vehicle accident, etc.)
Onset and severity of pain
Any swelling, deformity, or bruising of the leg
Difficulty walking or bearing weight
Past medical history (relevant conditions like bone diseases)
Medications (current medications)
Allergies
Objective
Vital signs (temperature, heart rate, blood pressure)
Physical exam:
Inspection (deformity, swelling, ecchymosis)
Palpation (localized tenderness, crepitus)
Neurovascular exam (distal pulses, capillary refill, motor and sensory function)
Range of motion of the hip and knee (if tolerated)
Imaging:
X-ray confirmation of femoral shaft fracture (location, displacement, angulation)
Assessment
Pediatric femoral shaft fracture:
Location (proximal, mid-shaft, distal)
Displacement (angulation, shortening, overriding)
Type of fracture (transverse, oblique, comminuted)
Closed fracture vs. open fracture
Injury severity score (if applicable)
Consider differential diagnoses (slipped femoral epiphysis, hip dislocation)
Plan
Treatment plan based on fracture characteristics and patient factors:
Non-operative management (closed reduction and casting) for minimally displaced fractures in younger children
Surgical management (internal fixation with pins, plates, or nails) for displaced fractures or older children
Pain management (medications)
Physical therapy (positioning, exercises to maintain muscle strength)
Weight-bearing restrictions (crutches, wheelchair) as tolerated
Follow-up X-rays to monitor healing
Prognosis
Discuss the expected healing time and potential complications:
Healing time varies depending on fracture type and treatment (typically 6-12 weeks)
Potential complications (malunion, nonunion, infection, stiffness)
Follow-up
Schedule for next appointment:
Close monitoring in the initial period (days 1-3)
Follow-up X-rays at regular intervals to monitor healing
Physical therapy referral
Note: This is a template and may need to be modified based on the individual patient’s presentation and fracture characteristics.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pediatric femoral shaft fractures.