Davos Courses

Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur 31-E/8 Removal of osteochondral fragment

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Glossary

Protected weight bearing

Introduction

After surgical stabilization, the construct should be sufficiently robust to allow protected weight bearing. Smaller children may not be able to comply with this and may need immobilization.

Mechanics

Forces through the hip are less with toe-touch weight bearing than with no weight bearing. Therefore, toe-touch is normally recommended for initial mobilization. This needs to be taught to children by a physiotherapist.


Range of movement

Range-of-movement exercises should start in the immediate postoperative period to prevent stiffness. Surgeons should indicate if any extremes of movement are forbidden.

Weight bearing

Having started with toe-touch weight bearing, children progress to partial weight bearing and then to full weight bearing according to their age and the predicted rate of healing of their fracture. 
Even older adolescents should be fully weight bearing without aids at three months.

Sports

Swimming can be allowed as soon as partial weight bearing is permitted.
Contact sports should be avoided for at least six months.

Follow-up x-rays

X-rays are generally taken immediately after the surgery and at 6 and 12 weeks.

Implant removal

Implants that cross the physis should be removed if there is significant growth remaining. The fracture should be healed and consolidated prior to removal.

Implants in young children should always be removed to prevent them from being covered by bony overgrowth.

Implant removal is not compulsory in adolescents.

v1.0 2017-12-04