Anterolateral approach for benign proximal femoral lesions among Indian children

Benign lytic lesions of the proximal femur in children cause pain, deformity, and pathological fractures, posing major challenges for bone stability and healing. Recent studies report pathological fractures in up to 32% of pediatric proximal femoral cysts and recurrence rates of about 17% after curettage and filling. Similarly, multicenter data from the European Paediatric Orthopaedic Society (EPOS) show failure rates of 36-43% in aneurysmal bone cysts of the proximal femur, highlighting the difficulty of achieving durable healing. Therefore, it is of interest to present the results of treating lytic lesions of the proximal femur in children through an anterolateral approach using curettage and non-vascularized fibular grafting. Hence, this retrospective study included 14 skeletally immature patients (mean age 7.1 years). The hip joint was exposed using the standard anterolateral approach, and fibula was harvested through a posterolateral incision. Aneurysmal bone cysts were the most common diagnosis (57.1%). Five patients (36%) required implant stabilization. At final follow up, all patients showed radiological healing at a mean of 4 months, with a mean Harris Hip Score of 78.8. Thus, the anterolateral approach with fibular grafting provides reliable exposure, facilitates bone healing, and allows implant use while preserving the lateral cortex in pediatric proximal femoral lesions.