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J Am Acad Orthop Surg, Vol 17, No 3, March 2009, 162-173.
© 2009 the American Academy of Orthopaedic Surgeons
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Hip Fractures in Children

Matthew J. Boardman, DO, Martin J. Herman, MD, Brian Buck, DO and Peter D. Pizzutillo, MD

Dr. Boardman is Orthopaedic Surgery Resident, Philadelphia College of Osteopathic Medicine, Philadelphia, PA. Dr. Herman is Assistant Professor, Pediatrics and Orthopedic Surgery, Orthopedic Center for Children, St. Christopher’s Hospital for Children, Philadelphia. Dr. Buck is Assistant Professor, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN. Dr. Pizzutillo is Chief, Orthopedic Surgery Section, Director, Orthopedic Center for Children, and Professor, Pediatrics and Orthopedic Surgery, St. Christopher’s Hospital for Children.

Dr. Pizzutillo or a member of his immediate family is affiliated with the publication Journal of Pediatric Orthopaedics and has received research or institutional support from Stryker. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Boardman, Dr. Herman, and Dr. Buck.

Matthew J. Boardman, DO, et al

Reprint requests: Dr. Herman, Section of Orthopedic Surgery, St. Christopher’s Hospital for Children, Erie Avenue at Front Street, Philadelphia, PA 19134-1095.

Hip fractures account for <1% of all pediatric fractures. Most are caused by high-energy mechanisms, but pathologic hip fractures also occur, usually from low-energy trauma. Complications occur at a high rate because the vascular and osseous anatomy of the child’s proximal femur is vulnerable to injury. Surgical options vary based on the child’s age, Delbet classification type, and degree of displacement. Anatomic reduction and surgical stabilization are indicated for most displaced hip fractures. Other options include smooth-wire or screw fixation, often supplemented by spica cast immobilization in younger children, or compression screw and side plate fixation. Achievement of fracture stability is more important than preservation of the proximal femoral physis. Capsular decompression after reduction and fixation may diminish the risk of osteonecrosis. Osteonecrosis, coxa vara, premature physeal closure of the proximal femur, and nonunion are complications that account for poor outcomes.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.