Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur 31-M/3.1 III

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Glossary

General considerations

Trochanteric fractures are extracapsular and therefore have a minimal risk of avascular necrosis (AVN).

Plate fixation is generally required to achieve angular stability.

Open reduction, pediatric hip locking plate
Main indication Skill Equipment
All trochanteric fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Contraindications

  • Image intensification not available
  • Local soft-tissue compromise

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
ESIN
Main indication Skill Equipment
Children up to 6-8 years of age (depending on body size) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Further indications

  • Local soft-tissue compromise
  • Pathological fractures (eg, unicameral bone cyst)

Contraindications

  • Children above 8 years of age and obese children
  • Insufficient bone stock in the proximal femur

Advantages

  • Indirect fracture reduction and fixation
  • No plaster cast required

Disadvantages

  • Less stable than pediatric hip locking plate
  • Final control of rotation after reduction may be challenging
  • Requires experience with flexible nails
*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