Very young patients can present to your clinic with a diaphyseal humeral or femoral. Unfortunately, they may not have an owner or the budget to have the fracture properly repaired.
Often the “second best choice for repair” is an amputation. However, these immature patients with femoral or humeral diaphyseal fractures can often do well with conservative management.
Conservative management in these cases usually entails crate rest, pain management, and repeating radiographs in 10-14 days. I do not advocate splinting, because (1) a femoral fracture should never be splinted and (2) a spica splint for a humeral fracture is often too bulky for these small, immature patients..
The limb function once there is a bridging callous tends to be excellent to adequate, depending on the amount of displacement in the fracture, because the heavy musculature around the humerus and femur tends to maintain the joints above and below the fracture reasonably aligned.
Also, at this very young, the fractures heal very quickly which contributes to a rapid return to function. If the healed bone is shorter than the contralateral one, the other bones in the limb and the joints tend to compensate for the disparity thus the shortened bone becomes unnoticeable.
I need to be clear that the best way to manage these fractures is with surgical repair but should that option not be available to that patient then I would recommend conservative management over amputation.
Of course, in the small percentage of patients in which conservative management does not result in adequate function and use of the limb, then amputation would be indicated.
