Related Experiment Video
Updated: Sep 20, 2025
Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts
Published on: October 20, 2023
Treatments and Sequelae of Pediatric Pathologic Proximal Femur Fractures Due to Benign Bone Cyst
Adrian J Lin1, Ali A Siddiqui1,2, Bensen Fan3
1Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Pediatric pathologic proximal femur fractures often require revision surgery and have high complication rates. Internal fixation is recommended over conservative management due to a high failure rate with casting.
Area of Science:
- Pediatric Orthopedics
- Pediatric Oncology
- Pediatric Traumatology
Background:
- Pathologic fractures of the proximal femur are common in children.
- Limited data exists on pediatric proximal femur fractures due to benign bone tumors.
- This study investigates outcomes for these specific fractures.
Purpose of the Study:
- To investigate the outcomes of pediatric pathologic proximal femur fractures.
- To analyze fracture healing, complications, and treatment effectiveness.
- To provide evidence-based recommendations for management.
Main Methods:
- Retrospective review of patients under 18 years old (2004-2018).
- Inclusion: pathologic proximal femur fracture from benign bone tumor.
- Exclusion: less than 1 year follow-up. Data collected on fracture classification, pathology, treatment, complications, and healing time.
Main Results:
- 14 patients included; mean age 6 years, mean follow-up 44 months.
- 68% treated with spica casting, 32% with internal fixation.
- 88% of casting group required revision vs. 40% of internal fixation group (P=0.05). 71% overall complication rate; 64% required revision surgery.
Conclusions:
- Pediatric pathologic proximal femur fractures have prolonged union times, high revision rates (64%), and significant complications (71%).
- Internal fixation is recommended over conservative management.
- Conservative management showed a 78% failure rate in this series.
Background:
The proximal femur is a common location for pathologic fractures in children, yet there is little published information regarding this injury. The purpose of this study was to investigate the outcomes of pediatric pathologic proximal femur fractures due to benign bone tumors.
Methods:
A retrospective review of patients treated for pathologic proximal femur fractures from 2004 to 2018 was conducted. Inclusion criteria were age below 18 years and pathologic proximal femur fracture secondary to a benign bone tumor. Patients were excluded if they had <1 year of follow-up. Medical charts and serial radiographs were reviewed for fracture classification, underlying pathology, treatment, complications, and time to fracture healing.
Results:
A total of 14 patients were included. Mean age was 6±3 (3 to 11) years, and mean follow-up was 44±21 (22 to 86) months. Index treatment was spica casting in 9/14 (68%) patients, while 5/14 (32%) were treated with internal fixation. Of the 9 patients initially treated with casting, 22% (2/9) required repeat spica casting at a mean of 0.6 months after index treatment, 67% (6/9) required internal fixation at a mean of 20.3 months after index treatment, and 11% (1/9) did not require revision treatment. Eighty-eight percent (8/9) of patients treated with casting required revision treatment compared with 40% (2/5) of those treated with internal fixation (P=0.05). Nonunion occurred after 1 refracture, malunion with coxa vara occurred in 2 fractures, and the remaining 11/14 (84%) fractures had a union at a mean of 4.9±3.0 months All cases of malunion occurred in patients initially treated nonoperatively. There were 19 distinct complications in 10/14 (71%) patients. The incidence of any revision surgery was 64% (9/14).
Conclusions:
In this series, pediatric pathologic proximal femur fractures demonstrated prolonged time to union, high incidence of revision surgery (64%), and substantial complication rate (71%). In children with pathologic proximal femur fractures, treatment with internal fixation is recommended as this series showed a 78% failure rate of initial conservative management.
Level Of Evidence:
Level IV.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:16Bones of the Lower Limb: Femur and Patella