Davos Courses

Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur 31-M/2.1 I

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Glossary

General considerations

Incomplete fractures are the principal indication for indirect fixation with K-wires, or screws. The goals of this fixation are to prevent secondary displacement, or completion of the fracture, and to allow early mobilization.

The choice of technique depends on:

  • The age of the child
  • The size of the child
  • The location of the fracture
  • The pattern of the fracture
Hip spica
Main indication Skill Equipment
Stable, incomplete fracture in a younger child Some specialized surgical experience Basic equipment only

Further indication

  • Image intensification not available

Contraindications

  • Local soft-tissue compromise
  • Obese patients

Advantage

  • May in some cases not require anesthesia

Disadvantages

  • Less stable than in situ fixation
  • Risk of secondary displacement
  • Patient care requires parental/carer compliance
In situ fixation with K-wires or screws
Main indication Skill Equipment
Stable, incomplete fracture Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Image intensification not available
  • Angular stability required (more distal fracture, eg, basicervical, trochanteric)

Advantage

  • Greater stability than hip spica

Disadvantages

  • Risk of implant penetration into joint
  • Risk of implant failure
  • Risk of pathological fracture at implant entry point
  • Requires anesthesia
  • Less stable than a plate
Pediatric hip locking plate
Main indication Skill Equipment
Incomplete fractures that require angular stability to avoid later displacement (more distal fracture, eg, basicervical, trochanteric) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Contraindication

  • Image intensification not available

Advantages

  • Anatomical reduction
  • Absolute stability
  • No additional immobilization required
  • Negligible risk of pathological fracture at implant entry point

Disadvantages

  • Plate removal may be necessary
  • Risk of implant penetration
  • Risk of implant failure
*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