The Hip: Preservation, Replacement and Revision

Hip Fractures in Children


- Timing:
    - references:
             - Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome.
             - Femoral Neck Fractures in Pediatric Patients: 30 Years Experience at a Level 1 Trauma Center
             - Fractures of the hip in children and adolescents
             - Earlier Time to Reduction did not Reduce Rates of Femoral Head Osteonecrosis in Pediatric Hip Fractures.
    - associated injuries:
             - trauma to triradiate cartilage or hemipelvis;

- Fracture Subtypes:
    - type I transepiphyseal separation: 
             - according to Moon, et al the rate of AVN was 38%;
             - transepiphyseal fracture of the femoral neck. 
    - type II, transcervical fractures:
             - most common type, accounting for about 50% of pediatric hip fractures;
             - most of these are displaced (80%) which relates directly to development of AVN;
             - rate of AVN is approx 28-50%, and it is controversial as to whether emergent reduction and IF will decrease probability of AVN; 
                     - according to Moon, et al the rate of AVN was 28%;
             - internal fixation is recommended for all type II frx because most are unstable;
             - it is controversial as to whether pins should cross the physis;
             - w/o internal fixation, both displaced and non displaced transcervical type II frxs tend to drift into coxa vara;
             - in young children, consider use of two pins, but otherwise use three pins;
                     - because of numerous problems w/ non compliance, a spica cast w/ the hip abducted is used for 6 weeks;
             - indications for preoperative hip aspiration (or intra-operative capsulotomy) remain unclear; 
             - references:
                     - Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. 
                     - Fractures of the femoral neck in childhood. Results of conservative treatment

    - type III: cervicotrochanteric fractures:
             - accounts for about 31% of pediatric hip fractures;
             - about one half of these frxs are displaced at the time of diagnosis;
             - similar to those occuring at base of femoral neck in adult, although AVN is more common in this fracture in child than in the adult; 
                     - according to Moon, et al the rate of AVN was 18%;
             - if frx is non displaced then consider several weeks of traction followed by abduction spica cast;
             - a displaced frx requires closed reduction and internal fixation w/ pins;
             - it is controversial as to whether pins should cross the physis;

               

    - type IV: intertrochanteric fracture:
             - least common;
             - these result in the fewest complications;
             - in the trochanteric area, rapid union usually occurs, within 6 weeks; 
             - according to Moon, et al the rate of AVN was 5%;
     - subtrochanteric fractures:
             - Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases.
             - Management of subtrochanteric fractures in skeletally immature adolescents.
             - Fracture of the neck and intertrochanteric region of the femur in children.

- Complications: AVN  (see avascular necrosis of the hip in adults)
   - consider decompression of the hip joint;
   - references:
          - Effect of early hip decompression on the frequency of avascular necrosis in children with fractures of the neck of the femur.  
          - Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. 
          - Complications associated with fracture of the neck of the femur in children.  
          - Effect of early hip decompression on the frequency of avascular necrosis in children with fractures of the neck of the femur
          - Pediatric femoral neck fractures require urgent reduction and decompression
          - Femoral neck fractures in children and the role of early hip decompression in final outcome.
          - Open Reduction of Pediatric Femoral Neck Fractures Reduces Osteonecrosis Risk
          - Osteonecrosis After Femoral Neck Fractures in Children and Adolescents: Analysis of Risk Factors




Current Concepts Review.  Fractures of the Head and Neck of the Femur in Children.

Decompression and Stable Internal Fixation of Femoral Neck Fractures in Children Can Affect the Outcome

Fractures of the hip in children and adolescents.  

Displaced hip fractures in children and adolescents

Fracture of the neck and intertrochanteric region of the femur in children.

Hip injuries in children and adolescents.

Long-term follow-up of children with femoral neck fractures

Hip fractures in children: a long term follow up study.  

Arthrotomy and open reduction of the displaced fracture of the femoral neck in children.

Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia

Factors affecting the outcome of fractures of the femoral neck in children and adolescents: A systematic review



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 10, 2016 7:09 am