**Question:** Treatment of choice for fracture shaft femur in a child less than 2 years of age

**Core Concept:** The management of pediatric femoral shaft fractures is crucial as it involves minimizing complications and achieving adequate fracture healing. In children less than 2 years old, open reduction and internal fixation (ORIF) is the preferred treatment option.

**Why the Correct Answer is Right:** In infants and young children, the immature bone structure and the risk of damaging the growth plate make closed reduction and percutaneous pinning (CRPP) an unsuitable choice. ORIF ensures precise reduction and fixation of the fracture, reducing the risk of complications like growth plate damage, malunion, and nonunion.

**Why Each Wrong Option is Incorrect:**

A. **Closed reduction and percutaneous pinning (CRPP):** This method is not recommended for young children due to the risk of damaging the growth plate, which is essential for proper bone growth and development.

B. **Salter-Harris classification:** This is a system used to classify pediatric distal femur and tibia fractures, not a treatment method.

C. **Salter-Harris classification:** Similar to option B, this is a classification system for pediatric distal femur and tibia fractures, not a treatment method.

D. **Hemiarthroplasty:** This surgical procedure is typically used for severe femoral neck fractures in adults, not for pediatric femoral shaft fractures.

**Clinical Pearl:** In pediatric femoral shaft fractures, ORIF provides the best outcome by minimizing complications and ensuring proper fracture healing. This treatment method is crucial in children less than 2 years of age, as the risk of growth plate damage is higher in this age group. Ensuring proper healing and minimizing complications is essential for the child's long-term growth and development.

**Correct Answer:** D. Open reduction and internal fixation (ORIF)

In summary, ORIF is the appropriate treatment for pediatric femoral shaft fractures, especially in children less than 2 years of age, as it minimizes complications and ensures optimal fracture healing, crucial for the child's long-term growth and development.