Davos Courses

Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur 31-E/8

back to Pediatric overview

Glossary

General considerations

A prerequisite for all of these procedures is that the surgeon be able to perform a surgical hip dislocation safely, if required.

Joint visualization will allow comprehensive assessment of the injury and aid in the choice of techniques listed below. MRI alone will not always provide accurate assessment.

Removal of osteochondral fragment
Main indication Skill Equipment
Small fragments which cannot be fixed Highly experienced and skilled surgeon Simple surgical and imaging resources

Advantages

  • No risk of failed fixation
  • No risk of fragment AVN
  • Allows immediate joint movement
  • Single procedure

Disadvantage

  • Defect on the articular cartilage surface which will be replaced only by fibrocartilage
Open reduction, resorbable pin fixation
Main indication Skill Equipment
Fragments that are largely cartilaginous Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Contraindication

  • Fragment that is too small for adequate fixation, in which case removal is more appropriate

Advantage

  • Low risk of additional cartilage damage compared to nonresorbable (prominent) implant(s)

Disadvantage

  • Low stability, especially compared to headless screws
Open reduction, headless screw fixation
Main indication Skill Equipment
Osteochondral fragments with enough bone for screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Contraindications

  • Chondral fragments
  • Small fragments (screw may split the fragment)

Advantages

  • Stability
  • Allows early mobilization
  • No implant removal

Disadvantage

  • Risk of implant protrusion
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2017-12-04