Proximal femoral fractures in children

Proximal femoral fractures in children can be divided into three groups: femoral neck fractures, apophyseal trochanteric separations and subtrochanteric fractures. Femoral neck fractures are extremely rare. They are classified according to Delbet and Colonna into four types. The more lateral is the line of the fracture, the better is the prognosis, and the less sequelae occur. The treatment of femoral neck fractures in children is in nearly all cases surgical, only in some pertrochanteric and in the minority of non-complete basicervical fractures conservative treatment can be considered. The surgical treatment is either a closed manipulation with internal fixation, or an open reduction with fixation. The authors prefer closed manipulation, if it is possible to perform. They have themselves treated 5 pathological separations of the femoral head of the coxxa vara adolescentium origin. These injuries are aligned with femoral neck fractures, because they are caused by a traumatic mechanism, and are to be treated like a fracture. Further the authors have treated two cervicotrochanteric fractures by open reduction and 4 patients with pertrochanteric fractures conservatively by skin traction. Apophyseal trochanteric separations are convenient to be treated conservatively, only in case of greater displacement of the greater trochater can an open reduction and internal fixation by traction cerclage be recommended because of the risk of a valgous deformation of the femoral neck. The authors have treated conservatively 3 patients with a separation of the lesser and 2 patients with a separation of the greater tochanter. Subtrochanteric femoral fractures are different from typical diaphyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)