Fractures of the Proximal Femur in Childhood: A Review
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REVIEW ARTICLE
Fractures of the Proximal Femur in Childhood: A Review Deepika A. Pinto1 · Alaric Aroojis1 Received: 9 August 2020 / Accepted: 7 September 2020 © Indian Orthopaedics Association 2020
Abstract Background Femoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications. Purpose To review the current knowledge, discuss controversial aspects, and provide suggestions for future research. Methods We have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed. Conclusion There is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries. Keywords Fracture neck femur · Paediatric · Avascular necrosis · Non-union · Coxa vara
Introduction Fractures of the femoral neck in children are rare injuries, comprising 20° angulation.
Historically, treatment for femoral neck fractures in children consisted of manipulation followed by immobilization using spica casts, Thomas splints or traction frames. Such nonoperative treatment is now largely obsolete, except for undisplaced or incomplete femoral neck fractures in very small children (
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