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Proximal Femoral Fractures in Children

Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S
 Hip fractures rarely occur in children but when they do they are potentially very
serious.
 The fracture is usually due to high velocity trauma; for example, falling from a
height or a car accident.
 Pathological fractures sometimes occur through a bone cyst or benign tumour.
 In children under two years, the possibility of child abuse should be considered.
 There is a high risk of complications, such as :
 avascular necrosis
 premature physeal closure
 coxa vara.
Classi fication
The most useful classification is that of Delbet , which is based on the level of the
fracture (Hughes and Beaty 1994) :-
.
o Type I is a fracture -separation of the epiphysis; sometimes the epiphyseal
fragment is dislocated from the acetabulum.
o Type II is a transcervical fracture of the femoral neck; this is the commonest
variety, accounting for almost half of the injuries.
o Type III is a basal (cervico -trochanteric) fracture, the second most common
injury.
o Type IV is an intertroc hanteric fracture .

Type I Type II Type III Type IV

Clinical features
 Diagnosis can be difficult, especially in infants where the epiphysis is not easily
defined on x -ray.
 Type I fractures are easily mistaken for hip dislocation.
 Ultrasonography, MRI and arthrography may help.
 In older children the diagnosis is usually obvious on plain x -ray examination.
Treatment
 These fractures should be treated as a matter of urgency, and certa inly within
24 hours of injury.
 Initially the hip is supported or splinted while investigations are carried out.
 Early aspiration of the intracapsula r haematoma is advocated as a means of
reducing the risk of epiphyseal ischaemia .
 Undisplaced fractures may be treated by immobilization in a plaster spica for 6 –
8 weeks, but there is a risk of late displacement and Malunion or non -union.

 Displaced type IV fractures also can be treated nonoperatively: - closed

reduction, traction and spica immobilization. Careful follow -up is essential; if
position is lost, operative fixation will be needed.
 Type I, II and III fractures are treated by closed reduction and then internal
fixation with smooth pins or cannulated screws.
Complications
 Avascular necrosis of the femoral head , it occurs in about 30 per cent of all
cases.
 Coxa vara Femoral neck deformity may result from malunion, avascular
necrosis or premature physeal closure.
 Diminished growth Physeal damage may result in retarded femoral growth. Limb
length equalization may be needed.

THANK YOU Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S


رفعت المحاضرة من قبل: Mubark Wilkins
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