Long-Term Outcomes of Decompression and Grafting in Acute Pathological Proximal Femur Fractures in Children with...

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Pediatric Trauma

Background:

• Unicameral bone cysts (UBCs) are common benign lesions causing pathological proximal femur fractures in children.
• Acute, unstable fractures require effective management strategies to ensure proper healing and minimize complications.

Purpose of the Study:

• To evaluate the outcomes of treating acute, unstable pathological proximal femur fractures secondary to UBCs in pediatric patients.
• To assess the efficacy of surgical fixation using a 120° fixed-angle low-contact locking pediatric plate (LCLPP) after cyst decompression and grafting.

Main Methods:

• Retrospective review of 12 pediatric patients (mean age 9.3 years) with proximal femur fractures due to UBCs.
• Treatment involved decompression and grafting of the cyst, followed by stabilization with a 120° fixed-angle LCLPP.
• Outcomes assessed included Musculoskeletal Tumor Society (MSTS) scores, Capanna classification, time to union, collodiaphyseal angle (CDA), and limb length discrepancy (LLD).

Main Results:

• Mean follow-up was 33.1 months, with a mean union time of 9.5 weeks.
• The collodiaphyseal angle (CDA) significantly improved post-operatively (120.8° to 140.9°).
• High mean postoperative MSTS score (97.1%) was achieved, with 10 out of 12 patients healing without complications.

Conclusions:

• Fixation of acute unstable fractures secondary to UBCs with a 120° fixed-angle LCLPP is a reliable and successful surgical option.
• This technique, combined with decompression and grafting, effectively manages these fractures in children.
• The study demonstrates good functional recovery and radiographic correction in pediatric patients treated with this approach.